***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES The purpose of this study ws to assess whether a community program begun in March 1988 that organized multiple city departments and private citizens could reduce  alcohol-impaired driving , related driving risks  , and  traffic deaths and injuries . METHODS Trends in fatal crashes and injuries per 100 crashes were compared in Saving Lives Program cities and the rest of Massachusetts from March 1984 through February 1993 . In annual roadside surveys conducted at r and omly selected locations , safety belt use among occupants of 54577 vehicles and travel speeds of 118442 vehicles were observed . Four statewide telephone surveys ( n = 15188 ) monitored self-reported driving after drinking . RESULTS In program cities relative to the rest of Massachusetts during the 5 program years in comparison with the previous 5 years , fatal crashes declined 25 % , from 178 to 120 , and fatal crashes involving alcohol decreased 42 % , from 69 to 36 . Visible injuries per 100 crashes declined 5 % , from 21.1 to 16.6 . The proportions of vehicles observed speeding and teenagers who drove after drinking were cut in half . CONCLUSIONS Interventions organized by multiple city departments and private citizens can reduce driving after drinking , related driving risks , and traffic deaths and injuries Abstract Objective To examine the extent and nature of outcome reporting bias in a broad cohort of published r and omised trials . Design Retrospective review of publications and follow up survey of authors . Cohort All journal articles of r and omised trials indexed in PubMed whose primary publication appeared in December 2000 . Main outcome measures Prevalence of incompletely reported outcomes per trial ; reasons for not reporting outcomes ; association between completeness of reporting and statistical significance . Results 519 trials with 553 publications and 10 557 outcomes were identified . Survey responders ( response rate 69 % ) provided information on unreported outcomes but were often unreliable — for 32 % of those who denied the existence of such outcomes there was evidence to the contrary in their publications . On average , over 20 % of the outcomes measured in a parallel group trial were incompletely reported . Within a trial , such outcomes had a higher odds of being statistically non-significant compared with fully reported outcomes ( odds ratio 2.0 ( 95 % confidence interval 1.6 to 2.7 ) for efficacy outcomes ; 1.9 ( 1.1 to 3.5 ) for harm outcomes ) . The most commonly reported reasons for omitting efficacy outcomes included space constraints , lack of clinical importance , and lack of statistical significance . Conclusions Incomplete reporting of outcomes within published articles of r and omised trials is common and is associated with statistical non- significance . The medical literature therefore represents a selective and biased subset of study outcomes , and trial protocol s should be made publicly available CONTEXT Selective reporting of outcomes within published studies based on the nature or direction of their results has been widely suspected , but direct evidence of such bias is currently limited to case reports . OBJECTIVE To study empirically the extent and nature of outcome reporting bias in a cohort of r and omized trials . DESIGN Cohort study using protocol s and published reports of r and omized trials approved by the Scientific-Ethical Committees for Copenhagen and Frederiksberg , Denmark , in 1994 - 1995 . The number and characteristics of reported and unreported trial outcomes were recorded from protocol s , journal articles , and a survey of trialists . An outcome was considered incompletely reported if insufficient data were presented in the published articles for meta- analysis . Odds ratios relating the completeness of outcome reporting to statistical significance were calculated for each trial and then pooled to provide an overall estimate of bias . Protocol s and published articles were also compared to identify discrepancies in primary outcomes . MAIN OUTCOME MEASURES Completeness of reporting of efficacy and harm outcomes and of statistically significant vs nonsignificant outcomes ; consistency between primary outcomes defined in the most recent protocol s and those defined in published articles . RESULTS One hundred two trials with 122 published journal articles and 3736 outcomes were identified . Overall , 50 % of efficacy and 65 % of harm outcomes per trial were incompletely reported . Statistically significant outcomes had a higher odds of being fully reported compared with nonsignificant outcomes for both efficacy ( pooled odds ratio , 2.4 ; 95 % confidence interval [ CI ] , 1.4 - 4.0 ) and harm ( pooled odds ratio , 4.7 ; 95 % CI , 1.8 - 12.0 ) data . In comparing published articles with protocol s , 62 % of trials had at least 1 primary outcome that was changed , introduced , or omitted . Eighty-six percent of survey responders ( 42/49 ) denied the existence of unreported outcomes despite clear evidence to the contrary . CONCLUSIONS The reporting of trial outcomes is not only frequently incomplete but also biased and inconsistent with protocol s. Published articles , as well as review s that incorporate them , may therefore be unreliable and overestimate the benefits of an intervention . To ensure transparency , planned trials should be registered and protocol s should be made publicly available prior to trial completion CONTEXT High-risk alcohol consumption patterns , such as binge drinking and drinking before driving , and underage drinking may be linked to traffic crashes and violent assaults in community setting s. OBJECTIVES To determine the effect of community-based environmental interventions in reducing the rate of high-risk drinking and alcohol-related motor vehicle injuries and assaults . DESIGN AND SETTING A longitudinal multiple time series of 3 matched intervention communities ( northern California , southern California , and South Carolina ) conducted from April 1992 to December 1996 . Outcomes were assessed by 120 general population telephone surveys per month of r and omly selected individuals in the intervention and comparison sites , traffic data on motor vehicle crashes , and emergency department surveys in 1 intervention-comparison pair and 1 additional intervention site . INTERVENTIONS Mobilize the community ; encourage responsible beverage service ; reduce underage drinking by limiting access to alcohol ; increase local enforcement of drinking and driving laws ; and limit access to alcohol by using zoning . MAIN OUTCOME MEASURES Self-reported alcohol consumption and driving after drinking ; rates of alcohol-related crashes and assault injuries observed in emergency departments and admitted to hospitals . RESULTS Population surveys revealed that the self-reported amount of alcohol consumed per drinking occasion declined 6 % from 1.37 to 1 . 29 drinks . Self-reported rate of " having had too much to drink " declined 49 % from 0.43 to 0.22 times per 6-month period . Self-reported driving when " over the legal limit " was 51 % lower ( 0 . 77 vs 0.38 times ) per 6-month period in the intervention communities relative to the comparison communities . Traffic data revealed that , in the intervention vs comparison communities , nighttime injury crashes declined by 10 % and crashes in which the driver had been drinking declined by 6 % . Assault injuries observed in emergency departments declined by 43 % in the intervention communities vs the comparison communities , and all hospitalized assault injuries declined by 2 % . CONCLUSION A coordinated , comprehensive , community-based intervention can reduce high-risk alcohol consumption and alcohol-related injuries result ing from motor vehicle crashes and assaults . JAMA . 2000;284:2341 - 2347 INTRODUCTION Persons who drive after drinking or ride with drinking drivers are at increased risk of motor vehicle crash . Although alcohol is involved in 40 % of fatal motor vehicle crashes yearly , there exist few systems to monitor alcohol-impaired driving . In this study we compare driver- and passenger-based estimates of the prevalence of alcohol-impaired driving . DESIGN A r and  om-digit-dialing telephone survey of the United States . Participants were adults aged 18 or older who were English- or Spanish-speaking from 5238 households ( response rate = 56.1 % ) . RESULTS From the 4603 respondents who reported driving in the preceding 30 days , we estimate that there were 126 million drinking-driving episodes in the United States in 1994 . From the 4380 passengers in the preceding 30 days , we estimate 191 million episodes . Three percent of respondents self-reported as drinking drivers ( 4.8 % of males and 1.3 % of females ) and 4.9 % as passengers of drinking drivers . Drinking drivers were more likely to be passengers of drinking drivers ( 44 % versus 4 % of nondrinking drivers ) . Drinking drivers were also more than twice as likely to report drinking daily , and only one half as likely to report always wearing their safety belts . CONCLUSION Passengers who report riding with a drinking driver may provide an important estimate of the prevalence of drinking driving . Passengers of drinking drivers represent a high-risk group that is not considered in most prevention efforts . Because being a passenger of a drinking driver is not illegal , it may be an easier topic for clinicians to broach than drinking and driving OBJECTIVE To establish a profile of injured adult pedestrians and attempt to define the role which alcohol plays in this regard . DESIGN Prospect i ve survey of injured pedestrians who presented consecutively over 9 weeks to Groote Schuur Hospital . Data on fatally injured pedestrians were retrospectively collected from the State Mortuary . SETTING Hospital-based study conducted at the trauma unit , Groote Schuur Hospital . PARTICIPANTS A total of 321 pedestrians--196 injured and 35 ' dead on arrival ' . MAIN OUTCOME MEASURES Sociodemographics ,  blood alcohol concentration ( BAC ) and injury severity . RESULTS Patients were predominantly male and , on average , 35.6 years old . They were most frequently injured at night and over weekends . The BAC was positive in 62.1 % of pedestrians , and the mean BAC was 0.19 g/dl . Most pedestrians had at least one lower limb injury and nearly half had a head injury ; however , BAC-positive pedestrians were 2.6 times more likely to have a head injury ( P = 0.0009 ) . Furthermore , BAC-positive pedestrians sustained more severe injuries , more frequently required admission to the ICU , had longer hospital admission and were more likely to die of their injuries . The overall case fatality rate was 19.5 % . CONCLUSIONS The influence of alcohol intoxication among injured adult pedestrians in Cape Town is high , suggesting that alcohol plays a major role in these accidents . Consequently , there should be some degree of culpability in those who cross the road while in an intoxicated state . However , equal attention should be given to safe and convenient crossing points , good lighting and education with regard to the wearing of reflective clothing after dark The methodology of r and omized control trials ( RCTs ) of the primary treatment of early breast cancer has been review ed using a quantitative method . Sixty-three RCTs comparing various treatment modalities tested on over 34,000 patients and reported in 119 papers were evaluated according to a st and ardized scoring system . A percentage score was developed to assess the internal validity of a study ( referring to the quality of its design and execution ) and its external validity ( referring to presentation of information required to determine its generalizability ) . An overall score was also calculated as the combination of the two . The mean overall score for the 63 RCTs was 50 % ( 95 % confidence interval [ CI ] = 46 % to 54 % ) with small and nonstatistically significant differences between types of trial . The most common method ologic deficiencies encountered in these studies were related to the r and omization process ( only 27 of the 63 RCTs adopted a truly blinded procedure ) , the h and ling of withdrawals ( only 26 RCTs included all patients in the analyses ) , the description of the follow-up schedule ( only 12 RCTs reported adequately ) , the report of side effects ( adequate information given in 33 RCTs ) , and the description of the patient population ( satisfactory in 29 RCTs ) . Telephone calls to the principal investigators improved the quality scores by seven points on a scale of 100 , indicating that some of the deficiencies lay in reporting rather than performance . There was evidence that quality has improved over time and that the increasing tendency of involving a biostatistician in the research team was positively associated with the improvement of the internal validity but not with the external AIMS To evaluate a large drunk-driving enforcement program at the US/Mexican border to reduce the number of youths crossing the border to drink in Tijuana . This paper also describes the research data used to develop and manage the program . Data from a border breath-test survey were used to dramatize the problem and gain public support for action . The data were also used to help design the enforcement effort and measure progress in reducing the cross-border drinking problem . DESIGN The number of news events generated around the occurrence of special enforcement efforts were used to measure project activity and to predict changes in the numbers of youths crossing into Mexico , their returning BACs and reductions in alcohol-related crashes during a 3-year period . SETTING An urban county on the Mexican border . PARTICIPANTS Underage youths aged 18 - 20 years and young adults aged 21 - 30 years residing in San Diego County . MEASUREMENTS Immigration and Naturalization Services provided population counts of the number of individuals crossing each weekend night from Tijuana into the United States through the San Ysidro border facility . Breath-test surveys of a r and om sample of these returning crossers provided data on the number of US residents visiting bars and nightclubs in Tijuana and on alcohol consumption at Tijuana bars and nightclubs . Night-time had-been-drinking crash data involving young drivers in several California counties served as an outcome measure of public health and safety . FINDINGS Analysis of data involving more than 2 million pedestrians returning from Tijuana indicated that the Operation Safe Crossing program reduced the number of late-night 
    Output:
    
Thus existing evidence , although supportive , does not firmly establish whether increased police patrols , implemented with or without other intervention elements , reduce the adverse consequences of alcohol-impaired driving