Alaska medicine
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Comparative Study
Comparison of young and adult driver crashes in Alaska using linked traffic crash and hospital data.
This report describes young driver crashes in Alaska, compares rates and characteristics of young driver crashes with adult driver crashes, and summarizes the medical and financial outcomes of young driver crashes, for the period 1991 through 1995. Using the Mini Crash Outcome Data Evaluation System (MINICODES), trauma registry hospital discharge data were linked with traffic crash records. The data were analyzed to compare drivers aged 16-20 with drivers aged 21-50 who were involved in a crash resulting in the hospitalization or death of a crash victim. ⋯ Young drivers were 2.9 times more likely than adult drivers to be involved in crashes that resulted in the hospitalization of a crash victim, and 2.6 times more likely to be involved in a crash involving a fatality. The contributing factors for young driver crashes were listed as human factors 73.4% of the time, compared with 65.6% among adults (P = .001). Costs associated with the young driver crashes were estimated to be over $300 million, which resulted in a cost per young licensed driver that was 3.4 times the cost per adult licensed driver.
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Opioids have long been associated with addiction and antisocial behavior. Yet recent experience and studies raise questions about the prohibition of chronic opioids in nonmalignant pain. From a purely pharmacologic point of view, opioids have perhaps the best side effect profile in our armamentarium. ⋯ Successful use of opioids for chronic nonmalignant pain depends on using them only when other measures have failed, when psychosocial and other addiction risk factors are clearly identified, and when guidelines and documentation are meticulous. Then opioids can often be used successfully to achieve good pain relief without undue risk of addiction or other side effects. The endpoint for opioid use is not the absolute dose of medications but rather the balance between benefits and side effects.