www.whohelmets.org/headlines/index.htm Headlines Newsletter Spring 2008 [selected articles]: www.whohelmets.org/headlines/08_spring_economics.htm Motorcycle Helmets - Economic Implications The WHO Helmet Initiative was established was to promote the use of helmets as an effective and efficient way to decrease mortality and reduce the number of head injuries throughout the world. Helmets – for motorcycle and bicycle riders – could be used universally, in high-income as well as in middle-income and low-income countries. Adnan Hyder and his colleagues at the Johns Hopkins Bloomberg School of Public Health in the USA, have reviewed some of the economic and policy implications of motorcycle helmets laws in low-income and middle-income countries. Because road traffic injuries are increasing worldwide – they’re expected to be the third leading cause of death and disability by 2020 – interventions like helmets are particularly important. According to Hyder and colleagues, there is no doubt that continued transfer of effective interventions for road traffic injuries is necessary from high-income to low-income and middle-income countries. The historical effectiveness of universal helmet wearing laws make them particularly attractive for low-income and middle-income countries. Considerable benefit cost ratios have been demonstrated from motorcycle helmets in high-income countries, and these effects may even be more pronounced in low-income and middle-income countries. This is because many of the road traffic injuries in these countries occur in people younger than 45, an age group that is the most economically productive segment in the population. Hyder and colleagues believe that evidence specifically relevant to middle-income and low-income countries needs to be generated and this evidence is essential to the development of policy and intervention strategies. Hyder AA, Waters H, Phillips T, Rehwinkel J. Exploring the economics of motorcycle helmet laws – implications for low and middle-income countries. Asia Pac J Public Health 2007;19:16-22. www.whohelmets.org/headlines/08_spring_cochrane.htm Motorcycle Helmets - Cochrane Review Updated An updated online version of the Cochrane Review, Helmets for Preventing Injury in Motorcycle Riders, was published in January, 2008. The Cochrane Collaboration is an international non-profit and independent organization, that makes up-to-date and , accurate information about the effects of healthcare readily available worldwide. The Collaboration does this by producing and distributing systematic reviews of interventions and by promoting the search for evidence in the form of clinical trials and other studies of interventions. Cochrane Reviews are based on the best available information about the evidence for and against the effectiveness and appropriateness of treatments and interventions. They are independent and objective. For those interested in helmets, Cochrane Reviews provide valuable summaries of research on the effectiveness of bicycle helmets, motorcycle helmets, and legislation to promote helmet wearing. The just-published review on motorcycle helmet effectiveness examined 61 observational studies. Although the studies were, according to the authors, of “varying quality”, they concluded that motorcycle helmets reduced the risk of death and head injury in motorcyclists who crashed, although the amount of reduction varied. In four “higher quality” studies, the risk of death was estimated to be 42%. In six other “higher quality” studies, the estimated reduction was 69%. Insufficient evidence was found to estimate the effect of motorcycle helmets compared with no helmet on facial or neck injuries. The authors, however, point out that studies of poorer quality suggest that helmets have no effect on the risk of neck injuries and are protective for facial injury. None of the studies provided enough evidence to demonstrate whether differences in helmet type confer more or les advantage in injury reduction. The authors concluded that motorcycle helmets reduce the risk of death and head injury in motorcycle riders who crash. They suggested that further research be undertaken to examine the effect of helmets and different helmet types on mortality, head, neck and facial injuries. Still, the authors suggested that in spite of gaps in knowledge, global efforts to reduce road traffic injuries may be facilitated by increasing helmet use by motorcyclists. Liu BC, Ivers R, Norton R, et al. Helmets for preventing injury in motorcycle riders. Cochrane Database of Systematic Reviews 2008, Issue 1. Art No.: CD004333. The Cochrane website: www.cochrane.org www.whohelmets.org/headlines/08_spring_usaneck.htm U.S.A. - Motorcycle Helmets and Neck Injuries A few months ago, we replied to a question from a public health official that asked whether or not wearing motorcycle helmets increased the incidence of spinal injuries. We indicated that we had not come across evidence that it did, and in fact, we believed that the ability of motorcycle helmets to reduce traumatic brain injury (TBI) far outweighed the risk of spinal injuries. Now, in a recent article in The Journal of Trauma, Goslar and her colleagues have documented that there is no statistical relationship between helmet use and cervical and thoracic fractures. Goslar used trauma registry data from a series of 11,000 trauma admissions, 422 of which involved motorcycle crashes. Age, sex, and blood alcohol levels were typical for motorcycle crashes. About 40% of the injured wore helmets. In Arizona, where this study was conducted, helmets are required only for those less than 18 years old. The protective effect of helmets was apparent. TBI occurred at a rate twice as high in motorcyclists not wearing helmets, and unhelmeted riders were three times more likely to die than helmeted ones. These rates are consistent with other helmet studies. Depending on whether in the cervical or lumbrosacral regions of the spine, fractures occurred in between 13 and 17% of all motorcycle crashes. The rate of cervical spinal fractures was similar for both helmeted and unhelmeted road traffic crash victims. Thoracic fractures were slightly more common in helmeted victims. The reverse was true for lumbrosacral fractures (i.e., lower in helmeted victims). None of the differences were statistically significant. In other words, helmeted and unhelmeted motorcyclists experienced about the same rate of spinal fractures. This real life observation is in contrast to cadaver and biomechanical computer modeling that indicates the extra weight added by a helmet to the head and neck can exacerbate hyperflexion and hyperextension injury to the neck. What did seem to affect spinal fractures was the speed the motorcyclist was traveling at the time of the crash; the faster the speed, the more likely spinal fractures occurred – in both unhelmeted and helmeted motorcyclists. Goslar PW, Crawford NR, Peterson SR, et al. Helmet use and associated spinal fractures in motorcycle crash victims. J Trauma 2008;64:190-196.