PubMed Health⌕ Search

Biomedical subjects

G McGwin

Publications and source records attributed to G McGwin.

At least 19 recordsLinked to original sources
PubMed2006

Systemic lupus erythematosus in a multiethnic US cohort (LUMINA) XL II: factors predictive of new or worsening proteinuria.

OBJECTIVES: To determine the factors predictive of new or worsening proteinuria in a large multiethnic cohort of patients with systemic lupus erythematosus (SLE). METHODS: Five hundred and twenty-nine SLE patients from a multiethnic US cohort [LUpus in MInorities: NAture versus Nurture (LUMINA)] were evaluated for new or worsening proteinuria using the categories of the Systemic Lupus Activity Measure-Revised: (1), normal; (2), trace or 1+ proteinuria on the dipstick; (3), 2-3+ proteinuria and (4), > or =4+ proteinuria. A rise in urinary protein was considered a positive event visit. Basic demographic and socioeconomic variables were assessed at baseline (T0). Clinical and immunological variables including disease features, activity, duration, comorbidities (such as hypertension and diabetes), medications and autoantibodies were assessed at the visit preceding a positive event visit. Selected HLA-DR and HLA-DQ alleles, and FCGR receptor polymorphisms were assessed. Data were analysed using logistic regression analyses and generalized estimating equations. RESULTS: There were 243 patients (59.1% of 93 Texan Hispanics, 37.0% of 100 Puerto Rican Hispanics, 58.0% of 181 African Americans and 29.7% of 155 Caucasians) with new or worsening proteinuria, and 364 positive events in 2801 visits. Younger age [Odds ratio (OR) = 1.013, 95% confidence limits (CL) = 1.001-1.024, P < 0.0334], anti-dsDNA (OR = 1.554, CL = 1.149-2.100, P < 0.0042), and HLA-DRB1*1503 (OR = 1.746, 95% CL = 1.573-2.2673, P < 0.0103) were found to independently predict the occurrence of new or worsening proteinuria. CONCLUSION: The factors predictive of new or worsening proteinuria include traditional factors associated with lupus nephritis, such as age and anti-dsDNA, as well as HLA-DRB1*1503, which has not been previously described in association with lupus nephritis, new or worsening proteinuria.

Adult↗
PubMed2006

Predictors of post-partum damage accrual in systemic lupus erythematosus: data from LUMINA, a multiethnic US cohort (XXXVIII).

OBJECTIVE: To determine the impact of pregnancy on systemic lupus erythematosus (SLE) outcome. METHODS: SLE patients, age >or=16 yrs, disease duration <or=5 yrs at enrolment in LUMINA, a multiethnic cohort (Hispanics, African-Americans and Caucasians), were studied. The first pregnancy after SLE diagnosis was examined. A good pregnancy outcome was a full-term delivery; an adverse outcome was a miscarriage, abortion, premature birth or stillbirth. Dependent variables were disease activity (Systemic Lupus Activity Measure-Revised, SLAM-R) and damage accrual [Systemic Lupus International Collaborating Clinics (SLICC) Damage Index, SDI]. Differences in these variables between the visit immediately prior to, and the first visit after, pregnancy and their relationship with pregnancy outcome were examined. Damage accrual due to pregnancy exposure was examined by a case-crossover design. RESULTS: Sixty-three SLE women from all ethnic groups were included. The mean (S.D.) age and disease duration at pregnancy outcome were 27.6 (6.5) yrs and 18.3 (22.5) months, respectively. Adverse pregnancy outcomes occurred in 76.2% women. The SLAM-R and SDI scores were statistically different after pregnancy (P = 0.050 and P < 0.001, respectively); the SDI score was independent of pregnancy outcome but strongly associated with pregnancy duration (P = 0.006), disease activity (P = 0.001), damage prior to pregnancy (P < 0.001) and total disease duration (P = 0.039) by multivariable analyses. Exposure to pregnancy itself did not impact on damage accrual in the case-crossover analyses of 142 patients (17 pregnancy exposures) (OR = 1.25; 95% CI 0.336-4.655; P = 0.480). CONCLUSIONS: Pregnancy duration, total disease duration, disease activity and damage immediately prior to pregnancy decisively impact on damage accrual after pregnancy in patients with SLE.

Adult↗
PubMed2006

Plasma apolipoproteins and risk for age related maculopathy.

AIM: To determine if elevated plasma levels of atherogenic and/or anti-atherogenic lipoproteins are risk factors for developing age related maculopathy (ARM). METHODS: In a cross sectional study in a university clinic setting, 129 patients (72 women and 57 men) underwent colour fundus photography, acuity and contrast sensitivity assessment, and electroimmunoassays of plasma apolipoproteins B (apoB) and A-I (apoA-I), the principal proteins of low density and high density lipoproteins, respectively. Maculopathy stage was assigned using the AREDS grading system. RESULTS: Levels of apoB in no ARM, mild, intermediate, and advanced ARM groups were 93.3, 91.8, 95.2, and 98.2 mg/dl, respectively. Levels of apoA-I were 147.4, 148.6, 141.0, and 144.9 mg/dl in the same groups. There was no significant association between these measures, typical for age, and maculopathy stage. CONCLUSION: Although drusen associated with ARM and ageing contain cholesterol and apoB, like the lipid rich core of an atherosclerotic plaque, the results of this study and our previous work in toto make the prospects of a plasma origin for these lesion constituents increasingly untenable. This conclusion is consistent with an emerging hypothesis that a large lipoprotein of intraocular origin is an important pathway for constituent retinal lipid processing and the biogenesis of drusen.

Aged↗
PubMed2006

Is there an association between pre-existing sleep apnoea and the development of glaucoma?

AIM: To determine if sleep apnoea is associated with an increased risk of developing glaucoma. METHODS: This was a nested case-control study. Patients seen at the Veterans Affairs Medical Center (BVAMC) in Birmingham, Alabama, with newly diagnosed glaucoma (cases) between 1997 through 2001 were selected (n = 667) and age matched with non-glaucomatous controls (n = 6667). Patient information was extracted from the BVAMC data files containing demographic, clinical, and medication information. An index date was assigned to the glaucoma subjects corresponding to the time of diagnosis. Patients who had a glaucoma diagnosis before the observation period of the study were excluded. 10 controls were randomly selected for each case and matched on age (plus or minus 1 year) and an encounter on or before the index date of the matched case. Ihe main outcome measures were crude and adjusted relative risks for the association between the previous diagnosis of sleep apnoea and the development glaucoma. Adjustment was performed for the associations of diabetes, lipid metabolism disorders, hypertension, cardiovascular disease, cerebrovascular disease, arterial disease, and migraines. RESULTS: Individuals who developed glaucoma were more likely to have a previous sleep apnoea diagnosis relative to control subjects. However, this finding was of borderline significance at an alpha of 0.05 (p value = 0.06, odds ratio = 2.20, 95% confidence intervals 0.967 to 5.004). Following adjustment for other potential risk factors, no significant difference was seen (p value = 0.18, odds ratio = 1.80, 95% confidence interval 0.76 to 4.23). CONCLUSIONS: This nested case-control study does not support a large impact of sleep apnoea on the eventual development of glaucoma relative to other putative risk factors.

Aged↗
PubMed2006

Systemic lupus erythematosus in a multiethnic cohort: LUMINA XXXV. Predictive factors of high disease activity over time.

AIM: To ascertain the predictive factors of high levels of disease activity in systemic lupus erythematosus (SLE). PATIENTS AND METHODS: Patients with SLE (American College of Radiology criteria), aged >or=16 years, with disease duration 10). A basic multivariable model (including age, sex, ethnicity, health insurance, social support, abnormal illness-related behaviours, helplessness and prior disease activity) was first examined. Additional models were built by including other variables. RESULTS: 554 patients (100 Hispanics from Texas, 94 Hispanics from Puerto Rico, 199 African Americans, 161 Caucasians) and 2366 visits were analysed; 47% of the patients and 29% of the visits met the definition of high disease activity (more common among African Americans (72.0%) and Hispanics from Texas (71.3%) than among Caucasians (43.9%) and Hispanics from Puerto Rico (31.9%)). Variables found to predict high levels of disease activity were Hispanic (from Texas) and African American ethnicities, lack of health insurance, helplessness, abnormal illness-related behaviours and poor social support; age was negatively associated with high levels of disease activity. African admixture and anti-double-stranded DNA antibodies also predicted high levels of disease activity, as did prior disease activity. None of the human leucocyte antigen variables were retained in the models. CONCLUSIONS: Socioeconomic-demographic (age, ethnicity, health insurance), behavioural and psychological variables are important mediators of high levels of disease activity in SLE during its course. Interventions aimed at modifiable factors may improve the outcomes of SLE.

Adolescent↗
PubMed2006

Non-arteritic anterior ischaemic optic neuropathy and the treatment of erectile dysfunction.

AIM: To determine the association between Viagra (sildenafil) and Cialis (tadalafil) and non-arteritic anterior ischaemic optic neuropathy (NAION). METHODS: A retrospective matched case-control study was conducted. 38 cases of NAION in males were identified from an academic ophthalmology practice in Birmingham, Alabama, and matched (on age) to 38 controls without a history of NAION. Self reported information regarding past and current use of Viagra and/or Cialis was obtained via a telephone questionnaire from interviewers who were not blind to case status. RESULTS: Overall, males with NAION were no more likely to report a history of Viagra or Cialis use compared to similarly aged controls (odd ratio (OR) 1.75, 95% confidence interval (CI) 0.48 to 6.30 and OR 1.82, 95% CI 0.21 to 15.39). However, for those with a history of myocardial infarction, a statistically significant association was observed (OR 10.7, 95% CI 1.3 to 95.8). A similar association was observed for those with a history of hypertension though it lacked statistical significance (OR 6.9, 95% CI 0.8 to 63.6). CONCLUSIONS: For men with a history of myocardial infarction or hypertension the use of Viagra or Cialis may increase the risk of NAION. Physicians prescribing these medications to patients with these conditions should warn them about the potential risk of NAION.

Carbolines↗
PubMed2006

Prevalence of transportation safety measures portrayed in primetime US television programs and commercials.

OBJECTIVE: To determine the prevalence of transportation related safety behaviors, such as seatbelt and helmet use, in primetime US television programs and commercials. DESIGN: Cross sectional study. SETTING: Top rated television programs and associated commercials from four major US television networks were reviewed for the prevalence of transportation safety related behaviors during a one month period in 2005. Programs were categorized according to the time and network of airing, program type, program rating, and--for commercials--type of product being advertised SUBJECTS: Occupants of automobiles, motorcycles, or bicycles in 507 instances in which a transportation scene was aired. RESULTS: Seatbelt use was depicted in 62% and 86% of individuals in television program and commercial automobile scenes, respectively. The prevalence of motorcycle helmet use was 47% in television programs and 100% in commercials. Bicycle helmets were used in 9% of television programs and 84% of commercials. The frequency of seatbelt use in programs and commercials varied by television rating and genre but did not differ by network, time of airing, or age of character portrayed. CONCLUSIONS: The prevalence of safety related behaviors aired on major US networks during primetime slots is higher than previous reports but still much lower than national averages. Commercials, in contrast, portray transportation safety measures with a frequency that exceeds that of US television programs or most national surveys.

Advertising↗
PubMed2006

Systemic lupus erythematosus in a multiethnic U.S. cohort (LUMINA) XXVII: factors predictive of a decline to low levels of disease activity.

The objective of this study was to examine factors predictive of a decline to low levels of disease activity in a cohort of systemic lupus erythematosus (SLE) patients. Patients with SLE of Hispanic (from Texas or Puerto Rico), African-American or Caucasian ethnicity from a multiethnic cohort were included. A decline to low levels of disease activity was defined as a score < or =5 as per the Systemic Lupus Activity Measure-Revised (SLAM-R) at any annual study visit if preceded by a SLAM-R > or =8. Using Generalized Estimating Equation (GEE), socioeconomic-demographic, behavioral, function, psychological, laboratory and clinical data [disease manifestations, number of ACR criteria accrued at diagnosis and damage accrual as per the Systemic Lupus International Collaborating Clinics (SLICC) Damage Index (SDI)] from the visit preceding that meeting the definition were examined as predictors of decline to low levels of disease activity. Two-hundred and eighty-seven patients (67 Hispanics from Texas, 32 Hispanics form Puerto Rico, 120 African-Americans and 68 Caucasians), accounting for 632 visits were analyzed. In the GEE multivariable analysis, higher degrees of social support (OR = 1.208, 95% CI 1.059-1.379; P = 0.005) were predictive of a decline to low levels of disease activity, while the number of ACR criteria accrued at diagnosis (OR = 0.765, 95% CI 0.631-0.927; P = 0.006) and damage (OR = 0.850, 95% CI 0.743-0.972, P = 0.018) were negatively associated. These data suggest that a decline to low levels of disease activity in lupus patients seems to be multifactorial; this study also underscores the importance of social support for lupus patients.

Adult↗
PubMed2006

Systemic lupus erythematosus in a multi-ethnic cohort (LUMINA) XXXII: [corrected] contributions of admixture and socioeconomic status to renal involvement.

Renal involvement in systemic lupus erythematosus (SLE) is more frequent in minorities. We examined whether genetic or socioeconomic status (SES) explain these disparities in a large multiethnic (Hispanics from Texas and Puerto Rico, African Americans and Caucasians) SLE cohort. Renal involvement was defined as WHO Class II-V and/or proteinuria (> 0.5 g/24 h or 3+) attributable to SLE and/or abnormal urinary sediment, proteinuria 2+, elevated serum creatinine/ decreased creatinine clearance twice, 6 months apart present any time over the course of the disease. Ancestry informative markers (AIMS) were used to define the admixture proportions in each patient and group. Logistic regression models were examined to determine the percentage variance (R2) in renal involvement related to ethnicity that is explained by socio-economic status (SES) and admixture (adjusting for age, gender and disease duration, basic model). Four-hundred and fifty-nine (out of 575) patients were included; renal involvement occurred in 44.6% Texas Hispanics, 11.3% Puerto Rico Hispanics, 45.8% African Americans, 18.3% Caucasians. SES accounted for 14.5% of the variance due to ethnicity (after adjusting for basic model variables), admixture 36.8% and both, 12.2%; 45.9% of the variance remained unexplained. Alternative models for decreased glomerula filtration rate and end-stage renal disease were comparable in the distribution of the explanatory variables. Our data indicate that genetic factors appear to be more important than SES in explaining the ethnic disparities in the occurrence of renal involvement.

Adult↗
PubMed2005

Systemic lupus erythematosus in a multiethnic US cohort (LUMINA): XXIV. Cytotoxic treatment is an additional risk factor for the development of symptomatic osteonecrosis in lupus patients: results of a nested matched case-control study.

BACKGROUND: Osteonecrosis is common in systemic lupus erythematosus (SLE) and often disabling. The role of glucocorticoids in its development is well known. OBJECTIVE: To explore other possible risk factors for osteonecrosis in SLE. METHODS: A nested matched case-control study undertaken in the context of a large, longitudinal, multiethnic lupus cohort (LUMINA), currently formed of 571 SLE patients meeting American College of Rheumatology criteria. All those developing symptomatic osteonecrosis after the diagnosis of SLE were considered cases. Two controls matched for age, disease duration, ethnicity, and centre were selected for each case. Cases and controls were compared by univariable analyses using selected variables. Variables with p<0.10 and those thought clinically relevant were entered into conditional logistic regression models including either the average dose or the highest dose of glucocorticoids, with osteonecrosis as the dependent variable. RESULTS: 32 cases were identified and 59 matched controls selected (in five cases only one control could be found). By univariable analyses, both groups were largely comparable for socioeconomic-demographic, clinical, and laboratory variables. Cases were less exposed to hydroxychloroquine (as assessed by the percentage of exposure time) (p = 0.026), used higher doses of glucocorticoids (average and highest doses) (p = 0.011 and 0.001, respectively), and received cytotoxic drugs more often (p = 0.015). In the multivariable analyses only cytotoxic drug use (both models) and the highest dose of glucocorticoids remained associated with the occurrence of osteonecrosis. CONCLUSIONS: Cytotoxic drug use is a risk factor for the development of symptomatic osteonecrosis in SLE patients, along with glucocorticoids. No definite protective factors were identified.

Adult↗
PubMed2005

Systemic lupus erythematosus in a multiethnic cohort (LUMINA): XXVIII. Factors predictive of thrombotic events.

OBJECTIVE: To determine the relationship between the presence of antiphospholipid (aPL) antibodies, hydroxychloroquine use and the occurrence of thrombotic events in patients with systemic lupus erythematosus (SLE). METHODS: Four hundred and forty-two SLE patients from the LUMINA (Lupus in Minorities: Nature vs Nurture) cohort, a multiethnic (Hispanics from Texas, n = 99 and Puerto Rico, n = 36; African Americans, n = 172; and Caucasians, n = 135) cohort, were studied by generalized estimating equation (GEE) to determine the relationship between antiphospholipid (aPL) antibodies (measured as IgG and IgM aPL antibodies and/or the lupus anticoagulant) at enrolment or historically prior to enrolment, hydroxychloroquine use (ever) and the occurrence of thrombotic (central and/or peripheral, arterial and/or venous) events after adjusting for known and possible confounders [socioeconomic-demographic features, smoking, disease activity and damage, serum cholesterol levels, anti-oxidized low-density lipoprotein IgG and IgM antibodies, and high-sensitivity (hs) C-reactive protein]. Postanalysis correlation between aPL and anticardiolipin (aCL) assays was attempted by performing aCL assays on random samples of patients whose aPL status was known. RESULTS: A number of clinical variables were significant in the univariable analyses; however, in the multivariable GEE analyses, only smoking [odds ratio (OR) 2.777, 95% confidence interval (CI) 1.317-5.852] and disease activity as measured by the SLAM (Systemic Lupus Activity Measure) (OR 1.099; 95% CI 1.053-1.147) were significant. In particular, hydroxychloroquine use, which appeared to be protective against thrombotic events in the univariable analyses, was not retained in the multivariable analyses. aPL antibodies were not significant in either analysis. Few additional aPL-positive patients emerged from the validation study. CONCLUSIONS: Smoking and disease activity emerged as important determinants in the occurrence of thrombotic events in our patients. Comprehensive treatment strategies should be directed to both smoking cessation and control of disease activity in patients with SLE.

Antibodies, Antiphospholipid↗
PubMed2005

Systemic lupus erythematosus in a multiethnic US Cohort (LUMINA). XXX: association between C-reactive protein (CRP) gene polymorphisms and vascular events.

OBJECTIVES: To determine if a polymorphic GTn repeat in the intron of the C-reactive protein (CRP) gene associates with occurrence of vascular arterial events in systemic lupus erythematosus (SLE). METHODS: We performed a nested case-control study on the LUMINA cohort of 546 Hispanic, African-American and Caucasian SLE patients. Twenty-five patients who developed vascular arterial events (i.e. myocardial infarction, angina, coronary artery bypass graft surgery, stroke, claudication, gangrene or significant tissue loss and/or arterial peripheral thrombosis) after enrolment were selected as cases and 32 ethnically matched patients with no previous vascular arterial events served as controls. Their CRP gene GTn polymorphism and plasma CRP was determined. RESULTS: Patients with vascular events had more severe SLE and were more likely to have plasma CRP in the highest quintile of measured values. The overall distribution of GTn alleles for patients with vascular events had a greater number of the GT20 variant compared with controls [26.0% of alleles (13/50) vs 15.6% (10/64)]. This greater number of GT20 in patients with vascular events was observed for African-Americans [29.2% (7/24) vs 21.0% (8/38)] and Hispanics [33.0% (4/12) vs 0% (0/16)] but not for Caucasians [14.3% (2/14) vs 20.0% (2/10)]. For African-Americans and Hispanics combined (45 patients), the frequency of GT20 in those with vascular events (30.6%, 11/36) was significantly higher than in those without them (14.8%, 8/54) (P<0.05, one-tailed test for difference in proportions). When patients were categorized according to the number of GT20 alleles they carried (thus GT20/GT20, GT20/GTx or GTx/GTx, where x is any allele other than GT20), for both African-Americans and Hispanics the likelihood of vascular arterial events increased in proportion with the GT20 dose, and all GT20-homozygous patients developed vascular arterial events. CONCLUSIONS: The CRP GT20 variant is more likely to occur in African-American and Hispanic SLE patients than in Caucasian ones, and SLE patients carrying the GT20 allele are more likely to develop vascular arterial events.

Adult↗
PubMed2005

The relation between C reactive protein and age related macular degeneration in the Cardiovascular Health Study.

AIM: To test the hypothesis that individuals with age related macular degeneration (AMD) have increased C reactive protein (CRP) levels. METHODS: A cross sectional study design using data from the Cardiovascular Health Study (CHS), a longitudinal study that enrolled older adults from four communities in the United States from 1989 to 1990, was employed to investigate the existence of an association between AMD and CRP levels in this population. Fundus photographs from 1997 and 1998 were used to identify individuals with (n=390) and without AMD (n=2365). The association between AMD and CRP levels (measured at baseline) was compared, adjusting for the potentially confounding effect of demographic, lifestyle, and health related characteristics. RESULTS: Among the 2755 CHS participants with gradable fundus photographs, 390 were identified as having AMD. Overall, median CRP levels among those with AMD (1.76 mg/l) were similar to those without AMD (1.77 mg/l). CRP levels were categorised into quartiles and compared between those with and without AMD. Relative to those in the lowest quartile (0.07-0.93 mg/l), the odds ratios (OR) in the higher quartiles, adjusted for demographic, lifestyle, and health related characteristics were increased but not statistically significant (0.94-1.77 mg/l: OR=1.14, 95% CI 0.82 to 1.60; 1.78-3.04 mg/l: OR=1.24, 95% CI 0.88 to 1.75; >3.04 mg/l: OR=1.24, 95% CI 0.87 to 1.78). CONCLUSIONS: In the CHS, there is no evidence that CRP levels are associated with AMD. These data do not support the theory alleging non-specific systemic inflammation in the aetiology and natural history of this disease.

Aged↗
PubMed2004

Frequency doubling technology perimetry in non-arteritic ischaemic optic neuropathy with altitudinal defects.

AIM: To determine if frequency doubling technology perimetry (FDT) is more sensitive to optic nerve injury in non-arteritic ischaemic optic neuropathy (NAION) than standard automated perimetry (SAP). METHODS: Charts from 18 patients (20 eyes) with NAION with altitudinal defects who underwent a complete neuro-ophthalmic examination, SAP, and FDT were reviewed. The extent of damage as determined by SAP, FDT, and clinical estimation of the regional extent of optic disc pallor was compared. 10 subjects (20 eyes) with normal ocular examinations and full appearing optic nerve heads were included as a control group. RESULTS: FDT demonstrated more extensive visual field defects in the relatively intact hemifield on SAP (proportion of locations at 5% or worse in the total deviation plot was 8.7% (SD 6.2%) for SAP and 38.3% (39.5%) for FDT p<0.0027). 16 of 20 eyes with altitudinal NAION demonstrated diffuse optic disc pallor. 11 of these eyes with diffuse pallor demonstrated significant defects in both hemifields using FDT, while only two eyes demonstrated diffuse damage using SAP. Correspondence between the extent of optic disc pallor and the extent of visual scotoma was higher for FDT (85%) than with SAP (40%). CONCLUSION: FDT appears more sensitive to axonal injury reflected by the extent of optic disc pallor in altitudinal NAION than SAP and in some patients reveals visual dysfunction in the hemifield that appeared relatively uninvolved when evaluated using SAP.

Adult↗
PubMed2004

Risk of injury for occupants of motor vehicle collisions from unbelted occupants.

OBJECTIVE: Unbelted occupants may increase the risk of injury for other occupants in a motor vehicle collision (MVC). This study evaluated the association between occupant restraint use and the risk of injury (including death) to other vehicle occupants. DESIGN: A population based cohort study. SETTING: United States. SUBJECTS: MVC occupants (n = 152 191 unweighted, n = 18 426 684 weighted) seated between a belted or unbelted occupant and the line of the principal direction of force in frontal, lateral, and rear MVCs were sampled from the 1991-2002 National Automotive Sampling System General Estimates System. Offset MVCs were not included in the study. MAIN OUTCOME MEASURE: Risk ratios and 95% confidence intervals for injury (including death) for occupants seated contiguous to unbelted occupants compared to occupants seated contiguous to belted occupants. Risk ratios were adjusted for at risk occupant's sex, age, seating position, vehicle type, collision type, travel speed, crash severity, and at risk occupants' own seat belt use. RESULTS: Exposure to unbelted occupants was associated with a 40% increased risk of any injury. Belted at risk occupants were at a 90% increased risk of injury but unbelted occupants were not at increased risk. Risks were similar for non-incapacitating and capacitating injuries. There was a 4.8-fold increased risk of death for exposed belted occupants but no increased risk of death for unbelted occupants. CONCLUSIONS: Belted occupants are at an increased risk of injury and death in the event of a MVC from unbelted occupants.

Accidents, Traffic↗