U of M News Wire: July 5, 2007

 
Seventy-two percent of Minnesota’s traffic fatalities happen on rural roads
 
By Justin Ware
U of M News Wire

Rural roads and highways may seem peaceful and safe, but in reality, 72 percent of Minnesota’s traffic fatalities happen on rural roads, according to a study just released by the national Center for Excellence in Rural Safety (CERS) at the University of Minnesota. Study results show a list of the states where Americans are more likely to die in a traffic crash on a rural road; and Minnesota makes the top 15.
 
While U.S. Census figures show that about two out of 10 (21 percent) Americans live in rural areas, the U.S. Department of Transportation has found that about six out of 10 (57 percent) highway deaths happen on roads that it considers rural.
 
Millions of Americans will be driving this summer and they would be wise to carefully consider these findings before they do, said CERS Director Lee Munnich, professor in the University of Minnesota's Humphrey Institute of Public Affairs. "America's rural byways seem so tranquil and safe, but the reality is that they can be as lethal as they are lovely," he said.
 
The states with the highest proportion of their total traffic fatalities occurring on rural roads are:
 
1) Maine (92%)
2) North Dakota (90%)
3) South Dakota (89%)
4) Iowa (88%)
4) Vermont (88%)
5) Montana (86%)
6) Wyoming (84%)
7) South Carolina (83%)
8) Mississippi (82%)
9) Arkansas (81%)
10) West Virginia (80%)
15) Minnesota (72%)
18) Wisconsin (68%)

The state-by-state rural fatalities data reflects deaths on rural roads in 2005 and was compiled by CERS researchers using information from the U.S. Department of Transportation. Rural roads are identified as those located outside of areas with a population of 5,000 or more. The entire list is available at www.ruralsafety.umn.edu.
 
There are many reasons for America's high rate of rural crash deaths. Head-on collisions and driving off the road crashes -- both of which are disproportionately deadly -- are common on the two-lane, undivided highways prevalent in rural areas. Rural roads, with lighter traffic and pleasant scenery, can easily lull drivers into a false sense of security. An over-relaxed comfort level can lead to motorists driving at unsafe speeds, distracted, fatigued, unbelted or impaired, all of which increase the likelihood of a crash. Additionally, emergency response time to a rural crash and hospital transport can be lengthy and thus jeopardize survival rate. Crash victims are five to seven times more likely to die from their injuries unless they arrive at a trauma center in the first half-hour following the crash.
 
"All states need to improve rural highway safety, but the issue is particularly pressing in these states," said Munnich. "Fortunately, there's much that can be done to prevent future deaths."
 
CERS works to raise awareness of the problem of rural road fatalities and advocate policy changes impacting road design and driver behavior. For instance, CERS advocates state adoption of primary seat belt laws, which allow law enforcement officers to pull people over for not using their seat belts. States that enact primary seat belt laws have increased their seat belt usage rates dramatically, by an average of 14 percent, which in turn reduces the number of injuries and deaths.
 
"This is a public health issue we must take much more seriously," said Munnich. "Two years ago, 23,549 Americans died on rural roadways. We are right to focus significant attention and resources on preventing things like AIDS, SARS, E coli poisoning and skin cancer, but we can't forget that this public health problem is even more deadly."
 
Traveling America's roads is particularly dangerous this time of year. According to the Insurance Institute for Highway Safety, the top two days of the year for motor vehicle fatalities over the years 1986-2002 have been July 3 and July 4.
 
 
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Umbilical cord blood is as good as bone marrow in treating leukemia
Cord blood need be less closely matched, opening the door for racial minorities and other hard-to-match groups

By Deane Morrison
U of M News Wire

In a stunning turn of fortune for leukemia patients, a University of Minnesota-led study has shown that children with the disease did just as well with transplants of umbilical cord blood as with transplanted bone marrow. Better yet, the cord blood didn't have to be matched to the recipient; as long as the degree of mismatch was limited and the number of cord blood cells available was sufficient, patients receiving cord blood had the same five-year leukemia-free survival rates as those who received bone marrow.
 
The work opens the door to providing a ready supply of white blood cells to leukemia patients from ethnic and racial minorities, who now have great difficulty finding a donor because they are underrepresented in volunteer marrow registries worldwide. The work appears in the June 9, 2007 issue of the journal Lancet.
 
"This has tremendous implications," says senior investigator John Wagner, a University of Minnesota professor of pediatrics and director of the division of pediatric hematology/oncology and bone marrow transplantation. "It means we can find donors now for a majority of our patients. In the United States, for African Americans [the capability is about] 20 percent, confined to partially matched donors in the marrow registries."
 
In matching, doctors try to minimize the chance that transplanted bone marrow or white blood cells will attack the tissues of the leukemia patient, a life-threatening condition called graft-versus-host disease. To do so, they examine four proteins, known as HLA antigens, that are found on the outer surfaces of cells and may provoke an immune response. Each person can have up to two variations of each HLA antigen. The "gold standard" for a match is when all eight (two variations on four proteins) are the same in both donor and recipient.
 
In their study, Wagner and his colleagues analyzed data from transplant centers around the country. The researchers compared 503 cord blood recipients with various degrees of mismatching to 282 "gold standard" matched bone marrow recipients, looking for difference in the five-year survival rate. The results were eye-opening.
 
In cord blood, "with every increment in mismatch, we found a correspondingly increased anti-leukemia effect. That means the risk of relapse of leukemia became substantially lower with every level of mismatch." Although it seems counterintuitive, such an effect is also known to occur with bone marrow transplants, but the study found it to be even stronger with cord blood. In other words, even with mismatched cord blood, overall five-year survival rates were comparable to the gold standard of bone marrow transplants, says Wagner. In both cases, the rate was about 38 percent. Umbilical cord blood also was associated with a lower risk of graft versus host disease.
 
"This is quite a surprise finding," he says. "It's of particular importance to those patients who can't even find donors in the marrow donor registries."
 
However, says Wagner, increasing levels of mismatch in cord blood transplants were associated with higher risks of death from transplant-related complications, most commonly infection. Higher numbers of cells in cord blood transplants improved survival rates.
 
Throughout the world, there are approximately 11 million volunteer donors ready to donate bone marrow, Wagner says. In contrast, there are about 300,000 units of cord blood banked so far. Even with such a relatively small supply of cord blood, Wagner says, "we can find donors for many of our patients, particularly those of racial minority descent, because we can use more mismatched transplants."
 
Now, it takes an average of two to four months to obtain marrow from adult volunteer donors. In contrast, cord blood units are already sitting in a bank, and can be used once a confirmatory typing for matching purposes is completed, which takes a week or two. It is crucial, says Wagner, to increase the diversity in cord blood banks. This past year, he says, the U.S. government released funds of approximately $100 million for augmenting the size of the cord blood registry.
 
Some issues remain, including the fact that the number of cells in a cord blood unit has a huge effect on how quickly the patient's bone marrow recovers after transplantation, as well as the risk of side effects such as infections. Therefore, Wagner says, not only must more units of cord blood be banked to increase their diversity of the population in the bank, but the number of cells in each unit must also be increased.
 
"What this study suggests is that cord blood need not be considered a second line of therapy any longer," says Wagner. "For the first time, the timing of transplantation can be dictated by the patient's needs, as opposed to the availability of the matched bone marrow."
 
 
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Growing Concerns
A parenting question-and-answer column with Dr. Martha Erickson of the University of Minnesota

Question: My husband and I are about to have our first child. My 75-year-old father-in-law is retired and has lots of time on his hands. He says he is eager to baby-sit and to take the baby on outings when my husband and I are at work. My mother-in-law still works full-time, so she will seldom be around to help. I really love my father-in-law and appreciate how excited he is about becoming a grandfather. But the problem is that over the past year he has become increasingly absent-minded and disorganized and my husband and I are not comfortable leaving the baby alone with him. I especially don’t want him to take the baby in the car because he has become a very erratic, dangerous driver. How can I draw these boundaries without offending him?
 
Answer: This is an awkward situation and it will be hard (if not impossible) to handle without hurting your father-in-law’s feelings. Nonetheless, as you well know, the consequences of not addressing the issue could be very serious.
 
As an in-law, you are not in the best position to take this on alone. I’d suggest that you and your husband decide together how to proceed. The two of you may decide that your husband should talk privately with his father -- or that the two of you should do it together. Either way, you will need to talk with your mother-in-law too and express your concerns. Most likely she has noticed the decline in her husband’s competence and, hopefully, will be supportive in helping make sure he has time with the baby within safe, manageable circumstances. She may even be relieved to know you’ve noticed these changes in her husband’s behavior and may welcome your support in helping her address her own concerns.
 
However you and your husband decide to address this sensitive issue with your father-in-law, I encourage you to lead with positives. Emphasize the things he will be able to do with his grandchild such as: helping care for the baby in your home to give you time to catch up on housework or take a break; going along when you run errands or take the baby to the park; taking the baby for a stroller ride around the block or rock the baby at naptime. Be straightforward about your concerns, but also tell him -- and show him -- how much you appreciate his involvement in your baby’s life.
 
Although your question to me was specifically about how your father-in-law’s poor driving and absent-mindedness could endanger your baby, what you describe raises a broader concern as well. You describe a significant change in your father-in-law’s mental capacity and behavior, which could be a sign of Alzheimer’s or some other serious illness or condition. Such decline often can be slowed by early diagnosis and treatment, so I urge you and your husband to pay close attention to these behavior changes and do what you can to see that your father-in-law is carefully evaluated by a physician. As difficult as it is to acknowledge that a loved one is slipping, denial or avoidance can cause much greater harm in the long run.