Depiction of elderly and disabled people on road traffic by jbw10297

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									Hazardous journeys

                       persisted after we had adjusted for major confounding             Funding: The Health Research Council of New Zealand funded
                       factors, but the possibility of residual confounding              the Auckland car crash injury study and the Road Safety
                                                                                         Research Trust funded this analysis.
                       remains. The extent to which these results are general-
                                                                                         Competing interests: None declared.
                       isable to other settings is open to question. Increasing
                       the proportion of silver cars could be an effective               1   Peden M, McGee K, Sharma G. The injury chart book: a graphical overview
                       passive strategy to reduce the burden of injury from car              of the global burden of injuries. Geneva: World Health Organization, 2002.
                                                                                         2   Lardelli-Claret P, De Dios Luna-Del-Castillo J, Juan Jimenez-Moleon J,
                       crashes.                                                              Femia-Marzo P, Moreno-Abril O, et al. Does vehicle color influence the
                                                                                             risk of being passively involved in a collision? Epidemiology 2002;13:721-4.
                                                                                         3   Connor J, Norton R, Ameratunga S, Robinson E, Civil I, Dunn R, et al.
                       We thank the study participants and I Civil, R Dunn, and J Bai-
                                                                                             Driver sleepiness and the risk of serious injury to car occupants: a popu-
                       ley for help with the design of the study.                            lation based case-control study. BMJ 2002;324:1125-8.
                       Contributors: SF was responsible for this analysis and writing    4   Connor J, Norton R, Ameratunga S, Robinson E, Wigmore B, Jackson R.
                                                                                             Prevalence of driver sleepiness in a random population-based sample of
                       the paper; JC, ER, RN, SA, and RJ contributed to the design and
                                                                                             car driving. Sleep 2001;24:688-94.
                       conduct of the study and the writing of the paper; ER and JC      5   Greenland S. Modeling and variable selection in epidemiologic analysis.
                       contributed to this analysis. JC is the guarantor.                    Am J Public Health 1989;79:340-9.




                       Depiction of elderly and disabled people on road traffic
                       signs: international comparison
                       Richard P Gale, Christopher P Gale, T A Roper, Graham P Mulley


Department of          The traffic sign for elderly or disabled people crossing
Ophthalmology,
York Hospital, York
                       the road was introduced in the United Kingdom in                  Countries that have road traffic signs warning motorists about
YO31 8HE               1981 after a children’s competition.1 It portrays a               elderly, disabled, blind, or deaf people
Richard P Gale         silhouette of a man with a flexed posture using a cane                                   Disabled        Elderly         Blind           Deaf
specialist registrar   and leading a kyphotic woman (fig 1). The same sign is            Country with sign       people         people         people          people
Department of          also used for frail, disabled, or blind people, even              Armenia                    X                             X              X
Cardiology, York
Hospital
                       though many of these people are not old. The sign                 Australia                                 X
                       implies that osteopaenic vertebral collapse and the               Bangladesh                 X                             X
Christopher P Gale
specialist registrar   need for mobility aids are to be expected with physical           Belarus                    X
                                                                                         Belize                     X
Department of          disability as well as with advancing age.
                                                                                         Canada                                    X
Medicine, The              Elderly people should not be stigmatised as being
General Infirmary                                                                        Cyprus                     X                             X              X
at Leeds, Leeds
                       impaired or inevitably disabled. We had observed that
                                                                                         Denmark                    X                             X
LS1 3EX                some countries did not depict these groups in this way
                                                                                         Estonia                    X              X              X
T A Roper              and wondered how road signs worldwide illustrate eld-             Finland                    X
consultant             erly people, as well as people with physical disabilities.        France                     X
Department of
                                                                                         Ghana                      X                             X
Elderly Medicine, St
James’s University     Participants, methods, and results                                Iceland                    X
Hospital, Leeds                                                                          Italy                      X
LS9 7TF                We obtained addresses from the British Diplomatic                 Latvia                                                   X
Graham P Mulley        List 2001,2 and we wrote to each of the 178 British               Lebanon                    X
professor
                       diplomats and consuls at all British missions abroad.             Lithuania                  X                             X              X
Correspondence to:
                       We requested a picture, photograph, or other image of             Malaysia                   X                             X
R P Gale
                       any road sign that warned about elderly people, as well           Namibia                    X              X
richard.gale@
york.nhs.uk            as deaf people, blind people, or any other people in              Norway                     X              X
                                                                                         Panama                     X
                       the neighbourhood with a physical disability. If we
BMJ 2003;327:1456–7                                                                      Russian Federation         X                             X              X
                       received no reply after eight weeks, we wrote again. We
                                                                                         San Marino                 X
                       followed up countries that failed to respond by
                                                                                         Seychelles                 X              X              X
                       contacting their embassies in the United Kingdom
                                                                                         Singapore                                 X              X
                       with up to two further letters. We also searched the              Slovakia                   X                                            X
                       world wide web for pictures of road traffic signs                 Slovenia                                                 X
                       specific to each country.                                         Sweden                     X                             X              X
                           We received 119 replies from British missions                 Switzerland                X
                       abroad and seven replies from British embassies, and              Thailand                   X
                       we found five countries with signs by using an internet           Tunisia                    X
                       search. This gave a total response rate of 131/178                Turkmenistan               X                             X              X
                       (74%). However, 13 countries replied to our questions             United Kingdom             X              X              X
                       but were unable to offer adequate information for the             United States              X

                       study, and alternative lines of inquiry failed to                 Vatican City               X

                       generate definitive answers. We believe the negative              All countries except the United Kingdom have separate signs to represent each
                                                                                         group of people. The UK road sign may be used alone to represent elderly,
                       responses are accurate—many countries (for example,               disabled, or blind people or with the caption “blind people” or “disabled
                       Argentina, Brunei, and Macedonia) informed us                     people.” The “elderly people” caption is being discontinued



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                                                                                                                                        Hazardous journeys

that their country did not have a road sign warning
of elderly, disabled, blind, or deaf people. Of the
118 countries for which we obtained information,
35 (30%) had a road traffic sign featuring one or
more of the elderly, blind, deaf, or disabled categories
(table).


Comment                                                                                                                                             Elderly People
In the 1960s the Worboys committee suggested that                                                   Fig 1 UK "elderly or disabled persons" Fig 2 Namibian "elderly persons"
                                                                                                          traffic sign                           road traffic sign
road traffic signs should be predominately symbolic,
because they are clearer from a distance.1 Only eight
countries that replied had a sign representing older
people (table). The Namibian sign illustrated a generic
picture of a pedestrian with the words “elderly people”
below (fig 2). This avoids stereotyping, but the sign
may not be as quickly or easily recognisable to the
speeding motorist. The Australian sign has a caption
only (fig 3).
    Most (24/30) signs warning of disabled people
                                                                                                    Fig 4 "Disabled persons" road traffic   Fig 5 "Deaf" road traffic sign (Lithuania)
were derived from the internationally recognised                                                           sign (France)
pictogram of a person using a wheelchair (a seated
person on a wheel; fig 4) Although many patients with
disabilities do not use a wheelchair, this is an easily rec-
ognisable sign.
    All seven countries that had a sign representing
deaf people used the internationally accepted logo of a
round yellow symbol containing smaller black discs in
a triangular formation (fig 5). We feel the meaning of
this sign is not widely known.                                                                                                                      Blind Persons
    Sixteen countries had road signs warning motorists         Fig 3 Australian "elderly persons"   Fig 6 "Blind persons" road traffic sign Fig 7 Bangladeshi "blind persons"
of blind people in the vicinity. A popular sign, particu-            road traffic sign                     (Armenia)                              road traffic sign

larly in the eastern bloc, illustrated a pair of “John
Lennon style” glasses (fig 6). Although many blind             these criteria. Before new designs and standardisation
people do not wear these glasses, this symbol is               are embarked on, however, research is needed to
informative and probably unobjectionable. A white              see if such signs improve the safety of these
stick also symbolises blindness; the Bangladeshi sign          pedestrians.
portrayed a stick (fig 7).
                                                               Contributors: RPG, CPG, and TAR did the collection and analy-
    Many replies suggested that secondary inquiries            sis of the data. All authors were involved in writing the paper.
had been made. However, we cannot corroborate this,            GPM is the guarantor.
and our study may be limited by the accuracy of the            Funding: None.
respondents.                                                   Competing interests: None declared.
    People should not be stigmatised on road traffic
signs, but signs must be clear and easily recognisable.        1   The history of British traffic signs, 2nd ed. London: Department for Trans-
                                                                   port, Local Government and the Regions, Traffic Signs Branch, 1999.
Perhaps an international agreement on the content              2   The Diplomatic Service List 2001. London: Great Britain Foreign and
and style of such road signs is needed to meet                     Commonwealth Office, 2000:21-38.




How long did their hearts go on? A Titanic study
James A Hanley, Elizabeth Turner, Carine Bellera, Dana Teltsch


Several studies have examined post-traumatic stress in         Subjects, methods, and results                                                           Correspondence to:
                                                                                                                                                        J A Hanley
people who survive disasters but few have looked at                                                                                                     James.Hanley@
longevity. The 1997 film Titanic followed one                  We limited our study to passengers. We used data from                                    McGill.CA
character, apparently fictional, but the longevity of the      biographies listed in Encyclopedia Titanica, a website
                                                                                                                                                        continued over
actual survivors, as a group, has not been studied. Did        that claims to have “among the most accurate passen-
the survivors of the sinking of the Titanic have               ger and crew lists ever compiled.”1 Of the 500 passen-                                   BMJ 2003;327:1457–8
shortened life spans? Or did they outlive those for            gers listed as survivors, 435 have been traced. We
whom 14-15 April 1912 was a less personal night to             calculated the proportion alive at each anniversary of
remember?                                                      the sinking.


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