Probabilistic model data of spatial-dependent crashes for ranking risk of road segments.

This article presents the databases analyzed and used to evaluate the risk of segment-based roads resulting from traffic crashes for three main motorways in UK from 2010 to 2014. The raw database is collection to many partial data for variables related to compute the crashes rates for each segment. These data were used to develop and select the best Bayesian probabilistic model presented in our research article (Kadhem et al., 2018) [1]. The data provided in this article would be an important source for studies that require evaluating statistical models and also to improve and develop the plans of traffic safety.

Biofield Frequency Bands-Definitions and Group Differences.

Background: In the biofield literature, it is suggested that electromagnetic energy is part of the biofield. However, little is known about the exact definition of potential electromagnetic biofield frequency bands (FBs).Primary Study Objective: The current study sought to identify biofield FBs and test potential group differences.Methods/Design: High-frequency (i.e. >200 Hertz) voltage was measured at body parts along the spine and the brain. Setting: Measurements were conducted in an electrically shielded laboratory. Participants: Twenty experienced biofield practitioners (BPs, sample 1) and twenty-four students (STs, sample 2) participated in the study. Interventions: The BPs performed a wide set of biofield exercises, while the STs participated in an assessment centre (with exercises such as role play). A total of N = 342 exercises were performed.Primary Outcome Measures: Based on surface electromyography, high-frequency (i.e., >200 Hertz) voltage was utilized as outcome measure. Results: 10 FBs were identified across all the data sets. The BPs had higher spectral power across these bands compared to the STs. Conclusion: The present paper presents a replicable method for the assessment of electromagnetic FBs which are potentially useful for future biofield research.

Inequity in cardiovascular care in the English National Health Service (NHS): a scoping review of the literature.

There is a general understanding that socioeconomically disadvantaged people are also disadvantaged with respect to their access to NHS care. Insofar as considerable NHS funding has been targeted at deprived areas, it is important to better understand whether and why socioeconomic variations in access and utilisation exist. Exploring this question with reference to cardiovascular care, our aims were to synthesise and evaluate evidence relating to access to and/or use of English NHS services around (i) different points on the care pathway (i.e. presentation, primary management and specialist management) and (ii) different dimensions of inequality (socioeconomic, age- and gender-related, ethnic or geographical). Restricting our search period from 2004 to 2016, we were concerned to examine whether, compared to earlier research, there has been a change in the focus of research examining inequalities in cardiac care and whether the pro-rich bias reported in the late 1990s and early 2000s still applies today. We conducted a scoping study drawing on Arksey & O'Malley's framework. A total of 174 studies were included in the review and appraised for methodological quality. Although, in the past decade, there has been a shift in research focus away from gender and age inequalities in access/use and towards socioeconomic status and ethnicity, evidence that deprived people are less likely to access and use cardiovascular care is very contradictory. Patterns of use appear to vary by ethnicity; South Asian populations enjoying higher access, black populations lower. By contrast, female gender and older age are consistently associated with inequity in cardiovascular care. The degree of geographical variation in access/use is also striking. Finally, evidence of inequality increases with stage on the care pathway, which may indicate that barriers to access arise from the way in which health professionals are adjudicating health needs rather than a failure to seek help in the first place.

Are healing ceremonies useful for enhancing quality of life?

OBJECTIVES: In line with the growing interest in integrated health care approaches, both nonindigenous (e.g., Western) and indigenous people are participating in healing ceremonies. However, little is known about the potential health-related benefit of healing ceremonies. Thus, the current study sought to close this gap in the literature by exploring the effect of healing ceremonies on participant's self-rated quality of life. DESIGN: Data were gathered at three time points (T1: 4 weeks before ceremony; T2: 2 days before ceremony; T3: 4 weeks after ceremony). PARTICIPANTS: 25 persons with various diseases participated in the healing ceremony. INTERVENTIONS: A 6-hour healing ceremony was conducted. OUTCOME MEASURES: Mental, physical, emotional, and spiritual quality of life were assessed. RESULTS: Participation in a healing ceremony increased mental, physical, emotional, and spiritual quality of life. CONCLUSIONS: As part of integrative health care, healing ceremonies are potentially useful for fostering participants' quality of life.

Overestimated crash risks of young and elderly drivers.

BACKGROUND: Young and elderly drivers are reported to have markedly greater crash rates than drivers of other ages, but they travel less frequently and represent a minority of road users. Consequently, many crashes involving young or elderly drivers also involve drivers of middle age ranges who travel more frequently. PURPOSE: To examine crash rates of young and elderly drivers, controlling for ages of all drivers involved in collisions. METHODS: A retrospective longitudinal study conducted on population-wide two-vehicle crashes reported in Great Britain from 2002 through 2010 for driver age ranges (17-20, 21-29, 30-39, 40-49, 50-59, 60-69, ≥70 years) and individual driver ages among those aged 17-20 years. Annual trips made, recorded as part of a National Travel Survey, were used to estimate trip-based driver crash rates. RESULTS: Crash rates of drivers aged 17-20 years were not significantly different from crash rates of drivers aged 21-29 years (rate ratio=1.14; 95% CI=0.96, 1.33) when controlling for ages of both drivers involved in two-car collisions, and drivers aged 17 years had the lowest crash rate among drivers aged 17-20 years. Crash rates of drivers aged ≥70 years equaled crash rates of drivers aged 60-69 years (rate ratio=1.00; 95% CI=0.77, 1.32) and were 1.40 times (95% CI=1.10, 1.78) lower than crash rates of drivers aged 50-59 years. CONCLUSIONS: The current findings are in contrast with reports of high crash risks among young and elderly drivers, and suggest that previous reports may have overestimated the crash risks of these drivers by failing to control for ages of all drivers involved in collisions.

Recruitment to online therapies for depression: pilot cluster randomized controlled trial.

BACKGROUND: Raising awareness of online cognitive behavioral therapy (CBT) could benefit many people with depression, but we do not know how purchasing online advertising compares to placing free links from relevant local websites in increasing uptake. OBJECTIVE: To pilot a cluster randomized controlled trial (RCT) comparing purchase of Google AdWords with placing free website links in raising awareness of online CBT resources for depression in order to better understand research design issues. METHODS: We compared two online interventions with a control without intervention. The pilot RCT had 4 arms, each with 4 British postcode areas: (A) geographically targeted AdWords, (B) adverts placed on local websites by contacting website owners and requesting links be added, (C) both interventions, (D) control. Participants were directed to our research project website linking to two freely available online CBT resource sites (Moodgym and Living Life To The Full (LLTTF)) and two other depression support sites. We used data from (1) AdWords, (2) Google Analytics for our project website and for LLTTF, and (3) research project website. We compared two outcomes: (1) numbers with depression accessing the research project website, and then chose an onward link to one of the two CBT websites, and (2) numbers registering with LLTTF. We documented costs, and explored intervention and assessment methods to make general recommendations to inform researchers aiming to use similar methodologies in future studies. RESULTS: Trying to place local website links appeared much less cost effective than AdWords and although may prove useful for service delivery, was not worth pursuing in the context of the current study design. Our AdWords intervention was effective in recruiting people to the project website but our location targeting "leaked" and was not as geographically specific as claimed. The impact on online CBT was also diluted by offering participants other choices of destinations. Measuring the impact on LLTTF use was difficult as the total number using LLTTF was less than 5% of all users and record linkage across websites was impossible. Confounding activity may have resulted in some increase in registrations in the control arm. CONCLUSIONS: Practitioners should consider online advertising to increase uptake of online therapy but need to check its additional value. A cluster RCT using location targeted adverts is feasible and this research design provides the best evidence of cost-effectiveness. Although our British pilot study is limited to online CBT for depression, a cluster RCT with similar design would be appropriate for other online treatments and countries and our recommendations may apply. They include ways of dealing with possible contamination (buffer zones and AdWords techniques), confounding factors (large number of clusters), advertising dose (in proportion to total number of users), record linkage (landing within target website), and length of study (4-6 months). TRIAL REGISTRATION: clinicaltrials.gov (Registration No. NCT01469689); http://clinicaltrials.gov/ct2/show/NCT01469689 (Archived by WebCite at http://www.webcitation.org/6EtTthDOp).

Risks of high-powered motorcycles among younger adults.

OBJECTIVES: We assessed whether policies designed to safeguard young motorcyclists would be effective given shifts in ownership toward high-powered motorcycles. METHODS: We investigated population-wide motor vehicle driver and motorcyclist casualties (excluding passengers) recorded in Britain between 2002 and 2009. To adjust for exposure and measure individual risk, we used the estimated number of trips of motorcyclists and drivers, which had been collected as part of a national travel survey. RESULTS: Motorcyclists were 76 times more likely to be killed than were drivers for every trip. Older motorcyclist age-strongly linked to experience, skill set, and riding behavior-did not abate the risks of high-powered motorcycles. Older motorcyclists made more trips on high-powered motorcycles. CONCLUSIONS: Tighter engine size restrictions would help reduce the use of high-powered motorcycles. Policymakers should introduce health warnings on the risks of high-powered motorcycles and the benefits of safety equipment.

Risk of fatal injury in older adult drivers, passengers, and pedestrians.

OBJECTIVES: To compare risk of fatal injury in elderly road users (drivers, passengers, pedestrians) with that of younger age groups and to assess the contribution of elderly road users to the number of reported fatalities in the population. DESIGN: Fatality age was categorized as 21 to 29, 30 to 39, 40 to 49, 50 to 59, 60 to 69, or 70 and older, and road user was categorized as driver, passenger, or pedestrian. Estimated number of trips made by each age group was used to adjust for exposure and to measure individual risk. SETTING: Fatalities recorded in Britain between 1989 and 2009. PARTICIPANTS: Population-wide fatal injury counts in Britain. MEASUREMENTS: Age of fatally injured drivers, passengers, and pedestrians. Estimated number of trips made per year by drivers, passengers, and pedestrians. RESULTS: Risk of fatal injury, but not fatality numbers in the population, were higher for older adult (≥ 70) drivers than for younger age groups. Risk of fatal injury was also high for older adult passengers and pedestrians, who represented the majority of older adult fatalities. CONCLUSION: Previous emphasis on driver impairment in older age has unduly focussed attention on elderly drivers, who represent a minority of all driver fatalities. Older adults represent a much larger proportion of passenger and pedestrian fatalities. Additional policy schemes and initiatives should be targeted at safeguarding older adult passengers and making the road environment safer for elderly pedestrians.

Do spiritual ceremonies affect participants' quality of life? A pilot study.

OBJECTIVES: As an attempt to explore and quantify the potential effects of spiritual ceremonies, the present study evaluated the effect of a spiritual ceremony on four independent facets of quality of life. DESIGN: Overall, ten persons participated in a half-day spiritual ceremony. Participants completed a survey on quality of life (a) four weeks prior to the ceremony (T1), (b) three days before (T2) and (c) four weeks after the ceremony (T3). RESULTS: Statistical analyses demonstrated that the ceremony had a positive effect on spiritual and mental quality of life. The ceremony did not enhance participants' physical and emotional quality of life. Implications for future research are discussed. CONCLUSIONS: Spiritual ceremonies might serve as a booster for spiritual and mental quality of life.

Do adverts increase the probability of finding online cognitive behavioural therapy for depression? Cross-sectional study.

OBJECTIVE: To estimate the effect of online adverts on the probability of finding online cognitive behavioural therapy (CBT) for depression. DESIGN: Exploratory online cross-sectional study of search experience of people in the UK with depression in 2011. (1) The authors identified the search terms over 6 months entered by users who subsequently clicked on the advert for online help for depression. (2) A panel of volunteers across the UK recorded websites presented by normal Google search for the term 'depression'. (iii) The authors examined these websites to estimate probabilities of knowledgeable and naive internet users finding online CBT and the improved probability by addition of a Google advert. PARTICIPANTS: (1) 3868 internet users entering search terms related to depression into Google. (2) Panel, recruited online, of 12 UK participants with an interest in depression. MAIN OUTCOME MEASURES: Probability of finding online CBT for depression with/without an advert. RESULTS: The 3868 users entered 1748 different search terms but the single keyword 'depression' resulted in two-thirds of the presentations of, and over half the 'clicks' on, the advert. In total, 14 different websites were presented to our panel in the first page of Google results for 'depression'. Four of the 14 websites had links enabling access to online CBT in three clicks for knowledgeable users. Extending this approach to the 10 most frequent search terms, the authors estimated probabilities of finding online CBT as 0.29 for knowledgeable users and 0.006 for naive users, making it unlikely CBT would be found. Adding adverts that linked directly to online CBT increased the probabilities to 0.31 (knowledgeable) and 0.02 (naive). CONCLUSIONS: In this case, online CBT was not easy to find and online adverts substantially increased the chance for naive users. Others could use this approach to explore additional impact before committing to long-term Google AdWords advertising budgets. TRIAL REGISTRATION: This exploratory case study was a substudy within a cluster randomised trial, registered on http://www.clinicaltrials.gov (reference: NCT01469689). (The trial will be reported subsequently).

General practitioner commissioning consortia and budgetary risk: evidence from the modelling of 'fair share' practice budgets for mental health.

OBJECTIVES: To contribute to current policy debates regarding the devolution of commissioning responsibilities to locally-based consortia of general practices in England by assessing the potential magnitude and significance of budgetary risk for commissioning units of different sizes. METHODS: Predictive distributions of practice-level mental health care resource needs (used by the Department of Health to set 'fair-share' practice budgets) are aggregated to a range of hypothetical, but spatially-contiguous, consortia serving populations of up to 400,000 patients. The resulting joint distributions describe the extent to which the legitimate mental health needs of consortia populations are likely to vary. Budgetary risk is calculated as the likelihood that a consortia's resource needs will, in any given year, exceed its allocation (taken as the mean of its predictive distribution) by more than 1%, 3%, 5% or 10%. The relationship between population size and budgetary risk is then explored. RESULTS: If between 500 and 600 consortia are created in England (serving 87,000 to 104,000 patients) then, in order to meet the legitimate mental health needs of their patients, each year around 15 to 26 consortia will overspend by at least 5%, and one or two by at least 10%. The budgetary risk faced by consortia serving smaller/larger populations can be read off the graphs provided. CONCLUSIONS: Unless steps are taken to mitigate budgetary risk, the devolution of decision-making and introduction of fixed budgets is likely to result in significant financial instability. It will be difficult to reconcile the policy objectives of devolved commissioning, best met through relatively small and fully accountable consortia, with the need for financial stability, which is best met by pooling risk across larger populations.

Referrals to a regional allergy clinic - an eleven year audit.

BACKGROUND: Allergy is a serious and apparently increasing public health problem yet relatively little is known about the types of allergy seen in routine tertiary practice, including their spatial distribution, co-occurrence or referral patterns. This study reviewed referrals over an eleven year period to a regional allergy clinic that had a well defined geographical boundary. For those patients confirmed as having an allergy we explored: (i) differences over time and by demographics, (ii) types of allergy, (iii) co-occurrence, and (iv) spatial distributions. METHODS: Data were extracted from consultant letters to GPs, from September 1998 to September 2009, for patients confirmed as having an allergy. Other data included referral statistics and population data by postcode. Simple descriptive analysis was used to describe types of allergy. We calculated 11 year standardised morbidity ratios for postcode districts and checked for spatial clustering. We present maps showing 11 year rates by postcode, and 'difference' maps which try to separate referral effect from possible environmental effect. RESULTS: Of 5778 referrals, 961 patients were diagnosed with an allergy. These were referred by a total of 672 different GPs. There were marked differences in referral patterns between GP practices and also individual GPs. The mean age of patients was 35 and there were considerably more females (65%) than males. Airborne allergies were the most frequent (623), and there were very high rates of co-occurrence of pollen, house dust mite, and animal hair allergies. Less than half (410) patients had a food allergy, with nuts, fruit, and seafood being the most common allergens. Fifteen percent (142) had both a food and a non-food allergy. Certain food allergies were more likely to co-occur, for example, patients allergic to dairy products were more likely to be allergic to egg.There were age differences by types of allergy; people referred with food allergies were on average 5 years younger than those with other allergies, and those allergic to nuts were much younger (26 Vs 38) than those with other food allergies.There was clear evidence for spatial clustering with marked clustering around the referral hospital. However, the geographical distribution varied between allergies; airborne (particularly pollen allergies) clustered in North Dartmoor and Exmoor, food allergies (particularly nut allergies) in the South Hams, and on small numbers, some indication of seafood allergy in the far south west of Cornwall and in the Padstow area. CONCLUSIONS: This study shows marked geographical differences in allergy referrals which are likely to reflect a combination of environmental factors and GP referral patterns. The data suggest that GPs may benefit from education and ongoing decision support and be supported by public education on the nature of allergy. It suggests further research into what happens to patients with allergy where there has been low use of tertiary services and further research into cross-reactivity and co-occurrence, and spatial distribution of allergy.

Usefulness of 64-detector row computed tomography for evaluation of intracoronary stents in symptomatic patients with suspected in-stent restenosis.

To determine whether 64-slice multidetector computed tomographic coronary angiography (MDCTA) can accurately assess the coronary artery lumen in symptomatic patients with previous coronary artery stents and potential in-stent restenosis (ISR). The primary aim was to determine the accuracy of binary ISR exclusion using MDCTA compared with invasive catheter angiography (ICA). Secondary aims were comparisons of stent dimensions measured using MDCTA and variables that affect accuracy. Forty patients with previous stent placement underwent both ICA and 64-slice MDCTA after elective presentation with chest pain, and ICA quantitative coronary angiographic data were used as the reference standard. Thirty-six men and 4 women (age 64 +/- 10 years; range 44 to 83) with 103 stents (2.8 +/- 1.6 stents/patient) were comparatively evaluated (stent exclusion rate 9.6%). There were 45 bare-metal and 58 drug-eluting stents (20 +/- 18 months after implantation) with an average diameter of 3.23 +/- 0.7 mm. Overall accuracy for the detection of significant ISR showed sensitivity, specificity, and positive and negative predictive values of 85%, 86%, 61%, and 96% for proximal stents > or =3 mm, which improved to 100%, 94%, 81%, and 100%; if the visible luminal diameter on MDCTA was <1.5 mm, accuracy decreased to 40%, 84%, 29%, and 90%, respectively. In conclusion, 64-slice MDCTA assessment of symptomatic patients with suspected clinically significant ISR is a realistic alternative to ICA if reference stent diameter is > or =2.5 mm and visible lumen cross-sectional diameter is > or =1.5 mm, for which a negative MDCTA result virtually excludes the presence of significant ISR.

Quantile regression provides a fuller analysis of speed data.

Considerable interest already exists in terms of assessing percentiles of speed distributions, for example monitoring the 85th percentile speed is a common feature of the investigation of many road safety interventions. However, unlike the mean, where t-tests and ANOVA can be used to provide evidence of a statistically significant change, inference on these percentiles is much less common. This paper examines the potential role of quantile regression for modelling the 85th percentile, or any other quantile. Given that crash risk may increase disproportionately with increasing relative speed, it may be argued these quantiles are of more interest than the conditional mean. In common with the more usual linear regression, quantile regression admits a simple test as to whether the 85th percentile speed has changed following an intervention in an analogous way to using the t-test to determine if the mean speed has changed by considering the significance of parameters fitted to a design matrix. Having briefly outlined the technique and briefly examined an application with a widely published dataset concerning speed measurements taken around the introduction of signs in Cambridgeshire, this paper will demonstrate the potential for quantile regression modelling by examining recent data from Northamptonshire collected in conjunction with a "community speed watch" programme. Freely available software is used to fit these models and it is hoped that the potential benefits of using quantile regression methods when examining and analysing speed data are demonstrated.

Cycle helmets and road casualties in the UK.

OBJECTIVES: Bicycle helmets have been advocated as a means of reducing injury among cyclists. This assertion, derived from a number of case controlled studies carried out in hospitals, conflicts with results from population level studies. In the Western countries where these case control studies have been performed, it appears that cycling morbidity is dominated by sports and leisure users. The generalizability of studies on helmet effectiveness in relation to utilitarian transport cycling is not clear. This study therefore considers population level data for reported road traffic injuries of cyclists and pedestrians. METHODS: Generalized linear and generalized additive models were used to investigate patterns of pedestrian and cyclist injury in the UK based on the police reported "Stats 19" data. Comparisons have been made with survey data on helmet wearing rates to examine evidence for the effectiveness of cycle helmets on overall reported road casualties. While it must be acknowledged that police casualty reports are prone to under-reporting, particularly of incidents involving lower severity casualties the attractive feature of these data are that by definition they only concern road casualties. RESULTS: There is little evidence in UK from the subset of road collisions recorded by the police corresponding to the overall benefits that have been predicted by the results of a number of published case controlled studies. In particular, no association could be found between differing patterns of helmet wearing rates and casualty rates for adults and children. CONCLUSIONS: There is no evidence that cycle helmets reduce the overall cyclist injury burden at the population level in the UK when data on road casualties is examined. This finding, supported by research elsewhere could simply be due to cycle helmets having little potential to reduce the overall transport-related cycle injury burden. Equally, it could be a manifestation of the "ecological fallacy" where it could be conceived that the existence of various sub-groups of cyclists, with different risk profiles, may need to be accounted for in understanding the difference between predicted and realised casualty patterns.

Epidemiology of child pedestrian casualty rates: can we assume spatial independence?

Child pedestrian injuries are often investigated by means of ecological studies, yet are clearly part of a complex spatial phenomena. Spatial dependence within such ecological analyses have rarely been assessed, yet the validity of basic statistical techniques rely on a number of independence assumptions. Recent work from Canada has highlighted the potential for modelling spatial dependence within data that was aggregated in terms of the number of road casualties who were resident in a given geographical area. Other jurisdictions aggregate data in terms of the number of casualties in the geographical area in which the collision took place. This paper contrasts child pedestrian casualty data from Devon County UK, which has been aggregated by both methods. A simple ecological model, with minimally useful covaraties relating to measures of child deprivation, provides evidence that data aggregated in terms of the casualty's home location cannot be assumed to be spatially independent and that for analysis of these data to be valid there must be some accounting for spatial auto-correlation within the model structure. Conversely, data aggregated in terms of the collision location (as is usual in the UK) was found to be spatially independent. Whilst the spatial model is clearly more complex it provided a superior fit to that seen with either collision aggregated or non-spatial models. Of more importance, the ecological level association between deprivation and casualty rate is much lower once the spatial structure is accounted for, highlighting the importance using appropriately structured models.

Investigating population level trends in head injuries amongst child cyclists in the UK.

Case control studies suggest that cycle helmets offer their wearers protection from injury in the event of an accident. Nevertheless, encouragement and even compulsion of cycle helmet wearing has been controversial. This paper will re-examine another potential source of evidence for the role of cycle helmets. Administrative datasets are attractive because of their availability, but require careful analysis. The results presented here are obtained from analysing such data with an appropriate form of generalised additive model. Whilst helmet wearing surveys in the UK suggest strongly divergent trends in wearing rates between male and female children, there is little evidence from "Hospital Episode Statistics" to indicate similarly divergent trends in terms of head injury. Conversely, it can be confirmed that head injuries are falling faster among cyclists than pedestrians. Although case control studies suggest cycle helmets are not effective in reducing overall injuries, it is worth noting an increase in the proportion of male child cyclists reported by the police as being killed or seriously injured in road collisions. It might be tempting to use these results to suggest that helmets are not effective in reducing head injury at the population level. Whilst the careful analysis of population level data presented here is clearly important, this paper will discuss the reasons why population and individual level analyses of cycle helmets might be different and consider some of the difficulties in assigning cause and effect with imperfect observational data.

Deprived children or deprived neighbourhoods? A public health approach to the investigation of links between deprivation and injury risk with specific reference to child road safety in Devon County, UK.

BACKGROUND: Worldwide, injuries from road traffic collisions are a rapidly growing problem in terms of morbidity and mortality. The UK has amongst the worst records in Europe with regard to child pedestrian safety. A traditional view holds that resources should be directed towards training child pedestrians. In order to reduce socio-economic differentials in child pedestrian casualty rates it is suggested that these should be directed at deprived children. This paper seeks to question whether analysis of extant routinely collected data supports this view. METHODS: Routine administrative data on road collisions has been used. A deprivation measure has been assigned to the location where a collision was reported, and the home postcode of the casualty. Aggregate data was analysed using a number of epidemiological models, concentrating on the Generalised Linear Mixed Model. RESULTS: This study confirms evidence suggesting a link between increasing deprivation and increasing casualty involvement of child pedestrians. However, suggestions are made that it may be necessary to control for the urban nature of an area where collisions occur. More importantly, the question is raised as to whether the casualty rate is more closely associated with deprivation measures of the ward in which the collision occurred than with the deprivation measures of the home address of the child. CONCLUSION: Conclusions have to be drawn with great caution. Limitations in the utility of the officially collected data are apparent, but the implication is that the deprivation measures of the area around the collision is a more important determinant of socio-economic differentials in casualty rates than the deprivation measures of the casualties' home location. Whilst this result must be treated with caution, if confirmed by individual level case-controlled studies this would have a strong implication for the most appropriate interventions.