INTRODUCTIONThis retrospective study aims to assess the epidemiology of road traffic accident (RTA) fatalities in Singapore, other causes of death besides trauma in a RTA, and identify the groups at risk.

MATERIALS AND METHODSData of 1038 RTA fatalities were reported between 2000 and 2004. Analyses using the Fisher's exact test for discrete variables and multivariate Cox regression analysis were performed to identify groups at risk. The risk of fatality was measured using the prevalence rate ratio (PRR).

RESULTSThe median age of victims in the sample was 36 years (interquartile range 24 to 55). Eight hundred and thirty six cases (78%) were in the economically productive age range of 15 to 65 years. Over the 5-year period, there was a preponderance of males. Majority of fatalities involved multiple injuries. There were also 64 (6.2%) and 25 (2.4%) cases of RTA fatalities from infective and cardiovascular (CVS) causes, respectively. Multivariate analyses showed that those > or = 60 years were 4 (95% CI of PRR, 3.04 to 5.43) times as likely to be pedestrian fatalities. Conversely, the risk of fatalities involving pedestrians and cyclists was reduced for males (PRR = 0.58; 95% CI, 0.46 to 0.73). However, males were at increased risk of fatalities involving motorcyclists, scooter and pillion riders (PRR = 1.96; 95% CI, 1.43 to 2.70), whereas such risk was reduced for those aged 30 to 59 (PRR = 0.70; 95% CI, 0.58 to 0.85) or > or = 60 years (PRR = 0.30; 95% CI, 0.21 to 0.42), respectively.

CONCLUSIONAs such, it appears that the groups at-risk had varying demographic characteristics. Public education could be modified to target these different groups to reduce the number of fatalities.

Accidents, Traffic ; mortality ; Adolescent ; Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Cause of Death ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Middle Aged ; Motorcycles ; Prevalence ; Risk Factors ; Sex Distribution ; Singapore ; epidemiology ; Walking ; Young Adult

Translational research (TR) can be defined as research where a discovery made in the laboratory (bench) can be applied in the diagnosis, treatment or prevention of a disease. Examples of medical discoveries contributing to translational medicine (TM) include the isolation of insulin by Banting (Nobel Laureate, 1923), the discovery of penicillin by Alexander Fleming (Nobel Laureate, 1945) and recently the discovery of the role of bacterium Helicobacter pylori in the causation of gastritis and peptic ulcer by Marshall and Warren (Nobel Laureates, 2005). Clinical research (CR) would be a more appropriate term for the bulk of research work undertaken by doctors. CR embraces both clinical based and laboratory-based research. The terminology "bedside to bench" applies more to CR as opposed to "bench to bedside" in the case of TR. But regardless of who does it, as long as the discovery can be translated to the bedside and results in improvement in patient care it can be considered a contribution to TM. Our work spans a 30-year period, involving laboratory-based research, clinical trials and genomics of IgA nephritis (Nx). This is a series of work to elucidate the pathogensis and therapy of IgANx. Plasma beta-thromboglobulin (BTG) an in-vivo index of platelet aggregation and anti-thrombin III increase due to a constant thrombogenecity resulting from platelet degranulation formed the basis for anti-platelet and low-dose warfarin therapy. A study of the natural history of IgANx revealed 2 courses, a slowly progressive course with end-stage renal failure (ESRF) at 7.7 years and a more rapid course at 3.3 years. Triple therapy (cyclophosphamide, persantin and low-dose warfarin) delayed progression to ESRF by about 8 years and for some patients up to 20 years. Documentation of abnormal suppressor T cell function provided the basis for immune therapy. Four patterns of proteinuria were present in IgANx and it is the quality and not so much the quantity of proteinuria which determined the prognosis. Low molecular weight proteinuria was a bad prognostic marker. A controlled therapeutic trial using ACEI/ATRA showed that therapy decreases proteinuria, improves renal function and converts non-selective to selective proteinuria. Subsequent work confirmed that it was the ATRA, not the ACEI which contributed to improved renal function. Individual anti proteinuria response to ATRA varies depending on ACE gene polymorphism. We found that the II genotype of the ACE gene was renoprotective and patients with this genotype had significantly reduced incidence of ESRF compared to those with the DD genotype. Patients responsive to ATRA therapy can retard progression to ESRF by up to 32 years. Mild renal failure can be reversed with possible regression of glomerulosclerosis because of glomerular remodelling by ATRA.
Disease Progression ; Evidence-Based Medicine ; history ; Genetic Predisposition to Disease ; Genomics ; history ; Glomerulonephritis, IGA ; genetics ; history ; History, 20th Century ; History, 21st Century ; Humans ; Polymorphism, Genetic ; Singapore