Adult attention-deficit hyperactivity disorder, risky behaviors, and motorcycle injuries: a case-control study

Association between quality of life, sleep quality and mental disorders in Iranian older adults

Aging as a major challenge can affect the development and growth of countries all around the world. This study aimed to identify the subgroups of the elderly based on the quality of life (Qol), sleep quality, and common mental disorders and assess the role of demographic characteristics on the membership of participants in each latent class. This cross-sectional study was conducted on 1064 people over the age of 60 years. The sample was selected through cluster sampling in northern Iran. All participants completed six sets of checklists and questionnaires. Data analysis was performed using latent class analysis. Three latent classes were identified; namely, (1) healthy (66.8%), (2) anxious and with poor sleep quality (28.6%), and unhealthy (4.6%). Being Female significantly increased the odds of membership in classes 2 and 3 compared to class 1. Furthermore, living in urban areas increased the odds of belonging to class 2 and class 3 compared to class 1. Illiteracy was also shown to increase the odds of being in class 3 in comparison to class 1. Results from the present indicate that the co-occurrence of health problems in 33.2% of the elderly was observed in various forms. The results of this study can be used in prioritizing health programs for the elderly and emphasizing high-risk groups.

Modeling Motorcyclists’ Aggressive Driving Behavior Using Computational and Statistical Analysis of Real-Time Driving Data to Improve Road Safety and Reduce Accidents

Driving behavior is considered one of the most important factors in all road crashes, accounting for 40% of all fatal and serious accidents. Moreover, aggressive driving is the leading cause of traffic accidents that jeopardize human life and property. By evaluating data collected by various collection devices, it is possible to detect dangerous and aggressive driving, which is a huge step toward altering the situation. The utilization of driving data, which has arisen as a new tool for assessing the style of driving, has lately moved the concentration of aggressive recognition research. The goal of this study is to detect dangerous and aggressive driving profiles utilizing data gathered from motorcyclists and smartphone APPs that run on the Android operating system. A two-stage method is used: first, determine driver profile thresholds (rules), then differentiate between non-aggressive and aggressive driving and show the harmful conduct for producing the needed outcome. The data were collected from motorcycles using -Speedometer GPS-, an application based on the Android system, supplemented with spatiotemporal information. After the completion of data collection, preprocessing of the raw data was conducted to make them ready for use. The next steps were extracting the relevant features and developing the classification model, which consists of the transformation of patterns into features that are considered a compressed representation. Lastly, this study discovered a collection of key characteristics which might be used to categorize driving behavior as aggressive, normal, or dangerous. The results also revealed major safety issues related to driving behavior while riding a motorcycle, providing valuable insight into improving road safety and reducing accidents.

A Comprehensive Review on the Behaviour of Motorcyclists: Motivations, Issues, Challenges, Substantial Analysis and Recommendations

With the continuous emergence of new technologies and the adaptation of smart systems in transportation, motorcyclist driving behaviour plays an important role in the transition towards intelligent transportation systems (ITS). Studying motorcyclist driving behaviour requires accurate models with accurate and complete datasets for better road safety and traffic management. As accuracy is needed in modelling, motorcyclist driving behaviour analyses can be performed using sensors that collect driving behaviour characteristics during real-time experiments. This review article systematically investigates the literature on motorcyclist driving behaviour to present many findings related to the issues, problems, challenges, and research gaps that have existed over the last 10 years (2011-2021). A number of digital databases (i.e., IEEE Xplore®, ScienceDirect, Scopus, and Web of Science) were searched and explored to collect reliable peer-reviewed articles. Out of the 2214 collected articles, only 174 articles formed the final set of articles used in the analysis of the motorcyclist research area. The filtration process consisted of two stages that were implemented on the collected articles. Inclusion criteria were the core of the first stage of the filtration process keeping articles only if they were a study or review written in English or were articles that mainly incorporated the driving style of motorcyclists. The second phase of the filtration process is based on more rules for article inclusion. The criteria of inclusion for the second phase of filtration examined the deployment of motorcyclist driver behaviour characterisation procedures using a real-time-based data acquisition system (DAS) or a questionnaire. The final number of articles was divided into three main groups: reviews (7/174), experimental studies (41/174), and social studies-based articles (126/174). This taxonomy of the literature was developed to group the literature into articles with similar types of experimental conditions. Recommendation topics are also presented to enable and enhance the pace of the development in this research area. Research gaps are presented by implementing a substantial analysis of the previously proposed methodologies. The analysis mainly identified the gaps in the development of data acquisition systems, model accuracy, and data types incorporated in the proposed models. Finally, research directions towards ITS are provided by exploring key topics necessary in the advancement of this research area.

Exploring the criteria and factors affecting firefighters' resilience: A qualitative study

PURPOSE

Firefighters are exposed to high levels of occupational risk factors, such as safety risks, chemical, ergonomic, and physical hazards that may jeopardize their lives. To overcome these hazards, firefighters must be physically, mentally, and personally fit to work. This study aimed to explore the criteria and factors affecting firefighters' resilience based on stakeholders' experiences.

METHODS

This qualitative study was carried out using conventional content analysis. In total, 21 face-to-face interviews were conducted by firefighters who were experienced in the field. The interviews were carried out from July 2019 to January 2020. The data were collected using 3 unstructured interviews and then resumed by 18 semi-structured interviews. Data analysis was done using Graneheim method.

RESULTS

The participants had more than 5 years of experience in the field of search and rescue. The extracted codes through data analysis were classified into 3 main categories (individual, organizational, and social factors), 9 sub-categories (mental, physical, occupational, managerial, colleagues-related, equipment-related, environmental, community-related, and family-related factors), as well as 19 sub-sub-categories and 570 codes.

CONCLUSION

Firefighters' personality, physical condition, behavior and psychological characteristics can affect their resilience along with organizational and management factors that play significant role in people's safety. Developing a tool for assessing resilience can help decision makers to have a real depict of firefighters' job qualifications.

Role of Health Sector in Road Traffic Injuries Prevention: A Public Health Approach

Background:

Although the main burden of the Road Traffic Injuries (RTIs) is on the health sector, compared with other sectors, no clear definition is available about its role in the prevention of the RTIs. So this study has been performed to define the role of the health sector in the prevention of RTIs –before the incidence.

Methods:

In this qualitative study with a grounded theory approach, the possible roles of the health sector in the prevention of the RTIs were identified in three phases. At the first stage of the study, the roles of the health system in the prevention of the RTIs identified from the literature. In the next step, semi-structured interviews (ranged from 45 to 90 minutes) with 42 experts were done for identifyingroles. Finally, Consensus attained on the identified roles by using the Delphi technique and with the participation of 30 experts.

Results:

Literature review and interviews resulted in 42 and 86 roles for the health sector in the prevention of the RTIs, respectively. After removing the duplicates and merging the similar, 46 roles were entered into Delphi. Five roles excluded in the Delphi leaving 41 roles in 7 dimensions of communications (6 roles), intra-sector cooperation (9 roles), inter-sector leadership (6 roles), evaluation (6 roles), research (5 roles), education (3 roles), and health-specific issues (6 roles).

Conclusions:

It seems that the health sector can help an impressing reduction of the RTIs by playing the roles identified in this study, which the most important of them is Communication/Informing role. So first the general public and then the health sector itself would benefit from it.

Factors Influencing Hospital Emergency Evacuation during Fire: A Systematic Literature Review

BACKGROUND

Although the hospital is known as a safe place for treating patients, due to various reasons, it is prone to several internal hazards, including fire. This study aimed to identify the factors affecting hospital emergency evacuation during fire.

METHODS

This was a systematic review conducted according to the PRISMA guideline. Thematic Content analysis was utilized to analyze and extract results. We found the studies investigating the factors affecting hospital emergency evacuation during fire through a comprehensive search in various data resources (MEDLINE, Web of Science, Google Scholar, Embase, ProQuest, Scopus, IRANMEDEX, SID, ISC, and Magiran) and other sources from the beginning of January 2000 to the end of December 2019. Thematic Content analysis was also employed to analyze.

RESULTS

At first and based on the initial search, 4484 studies were identified, and 48 articles were finally included in the study. Based on the results; five main themes along with 10 sub-themes were identified. The themes included the incident's characteristics, response measures, hospital preparedness, hospital residents, and hospital building, and the sub-themes were emergency evacuation features, fire characteristics, command, operation, patients' and staff's characteristics, planning, logistics, and structure and design hospital.

CONCLUSIONS

Based on the results of the present study, hospital preparedness as one of the most important factors can reduce the hospital evacuation time. Therefore, hospitals can ensure a timely and more effective response in emergency evacuation during fire by improving their preparedness.

Factors affecting emergency evacuation of Iranian hospitals in fire: A qualitative study

BACKGROUND

Fire is one of the most important threatening factors for hospitals and needs special attention. The present study was conducted to explain the factors affecting hospital emergency evacuation following fire based on hospital administrators' experiences.

MATERIALS AND METHODS

This was a qualitative study conducted employing the content analysis approach. Participants included 22 hospital administrators in Tehran, Lorestan, Kurdistan, and Ilam provinces. The participants were purposefully selected and included until reaching principle of data saturation. Data were collected through in-depth semi-structured interviews from November 2019 to August 2020 and analyzed by the content analysis method.

RESULTS

Factors affecting hospital emergency evacuation during fire were categorized into five main categories and 17 subcategories including response to incident (five subcategories of fire nature, emergency evacuation, service provision, coordination and communication; and collaboration and companionship), human factors (two subcategories of individual characteristics and competencies), hospital preparedness (three subcategories of planning, safety and security; and information management system), environmental factors (two subcategories of hospital design and infrastructure; and weather condition), and finally ethical values (five subcategories of human dignity, trust, altruism, responsibility and accountability; and empathy).

CONCLUSION

The results of this study indicated that during fire in Iranian hospitals, several factors in addition to available standard guidelines affect the emergency evacuation process that need to be considered. Hospital emergency evacuation during fire is a complex process and necessitates a full and high-level hospital preparedness, so using the results of this study can be used to develop and practice evacuation plans and improve the hospital preparedness.

A Hybrid of Structural Equation Modeling and Artificial Neural Networks to Predict Motorcyclists' Injuries: A Conceptual Model in a Case-Control Study

Background:

To model, the predictors of injuries caused the hospitalization of motorcyclists using a hybrid structural equation modeling-artificial neural network (SEM-ANN) considering a conceptual model.

Methods:

In this case-control study, 300 cases and 156 controls were enrolled using a cluster random sampling. The cases were selected among injured motorcyclists in refereed to Imam Reza Hospital and Tabriz Shohada Hospital, Tabriz, Iran since Mar 2013. The predictability of injury by motorcycle-riding behavior questionnaire (MRBQ), Attention-deficit/hyperactivity disorder (ADHD) along with its subscales and motorcycle related variables was modeled using SEM-ANN. By SEM, linear direct and indirect relationships were assessed. To improve the SEM, the ANN was utilized sequentially to account for the nonlinear and interaction effects that is not supported by SEM.

Results:

The predictors of injury were: MRBQ, ADHD, and its subscales, marital status, education level, riding for fun, engine volume, hyper active child, dark hour riding, cell phone answering, driving license (All P less than 0.05). In addition, the findings reveal the Mediating role of MRBQ for the relationship between underlying predictors and injury. Furthermore, ANN showed higher specificity (95.45 vs.77.88) and accuracy (90.76 vs.79.94) than usual SEM which lead us to introduce the second and third order effect of MRBQ into the modified SEM.

Conclusion:

The hybrid model provided results that are more accurate; considering the results of the modeling, having intervention programs on ADHD motorcyclists, those have the hyperactive child, and those who answer their cell phones while driving, and improving the motorcyclists’ goal is highly recommended.

Attention Deficit Hyperactivity Disorder (ADHD) in Patients with and without Head Trauma

Purpose

Attention deficit hyperactivity disorder (ADHD) in adults is one of the psychological problems that can increase the risk of accidents and trauma, especially head trauma. Recent studies have reported the frequency of adult attention deficit hyperactivity disorder (ADHD) among trauma patients. Adult AD0HD has been reported in trauma patients. In the present study, we hypothesized that adult ADHD was more common among head trauma patients following an accident compared to a group without trauma.

Materials and Methods

In this case-control study, 230 patients with head injuries and 460 non-trauma patients were selected. The adult Connors self-report screening scale (CAARS-SV) was used to screen for ADHD. Three subscales as subscale A (attention deficit index), subscale B (hyperactivity index) and subscale D (ADHD index) were evaluated between the two groups. Using linear multiple regression analysis, the effect of group, age, gender, and socioeconomic variables on ADHD scores was evaluated.

Results

The total frequency of adult ADHD was 9.5%, which was equal to 1.6% in the trauma group and 9.5% in the non-trauma group. The experimental group had more drivers as the job (11.7% vs 3.7%, P<0.001) compared to the control group. Of the Connors subscales, only the D subscale was significantly lower in the case group than in the control group (6.35 6 5.11 vs 51.72 4 72.4, P=0.003). The prevalence of ADHD in patients with head trauma and non-trauma head injury was 6.1% and 5.9%, respectively, which did not show a statistically significant difference (P=0.9). Linear regression analysis showed that the subscale D only had a significant relationship with group and age. However, by entering variables in logistic regression analysis, it was observed that only the age variable was significant in the presence of other variables.

Conclusion

According to the results of the present study, the frequency of adult ADHD in trauma patients, as a screening diagnosis, was not found to be higher than non-traumatic patients.

Road safety data collection systems in Iran: A comparison based on relevant organizations

PURPOSE

Various organizations and institutions are involved in road traffic injury (RTI) and crash registration such as police, forensic medicine organization, hospitals and emergency medical services. But there is a substantial uncertainty in interpreting the data, duplicated data collection and missing data in relation to RTI in most systems. This study aims to identify data sources for RTI surveillance in Iran and to explore traffic safety data source domains, data elements and detailed information by each data source.

METHODS

This is a qualitative study which was conducted in 2017 in Iran. Data were collected employing semi-structured interviews with informants in road safety organizations in relation to traffic safety including Police, Ministry of Health and Medical Education as well as Forensic Medicine Organization and other authorities-in-charge. For completing the preliminary extraction information, the minimum data set was used and compared in each system.

RESULTS

Eight different organizations relevant to road traffic safety were identified. The main domain of data provided by each one consists of Emergency Medical System form, Police KAM114 form, Ministry of Transport and Road Administration, Red Crescent Organization/Disaster Management Information System, Ministry of Health and Medical Education, Forensic Medicine Organization, Insurance Company and Ministry of Justice. Each system has its own database, based upon its scope and mainly at crash and post-crash status and little on pre-crash circumstance.

CONCLUSION

All current registry systems are not surveillance systems for RTI prevention. Huge data have been collected in various registry systems in Iran, but most of the collected variables are duplicated in each system. On the other hand, some variables like alcohol and substance abuse, child seat belt, helmet use in relation to RTI prevention are missed in all systems. Accordingly, it is a critical need to integrate and establish a comprehensive surveillance system, with focus on the goal of each system and collection of minimum data in each organization, which currently is underway.

Association between Adult Attention-Deficit/Hyperactivity Disorder and Driving Behaviors among Iranian Motorcyclists

Objective

To investigate the association between attention-deficit/hyperactivity disorder (ADHD) score and driving behaviors among motorcycle drivers in Iran.

Methods

This multi-center cross-sectional study was conducted on 1747 motorcyclists in three cities of Iran. We used a random sampling method in this study and gathered data using two standard questionnaires. Data were presented using descriptive statistics, also t-test, and ANOVA used for analysis.

Results

The mean age of participants was 27.41±8.80 years. ADHD scores of the participants ranged from 0 to 87, with a mean score 31±15.86. All risky driving behaviors (RDBs) were significantly associated with a higher mean of ADHD score. For example, driving with illegal speed (p<0.001), not wearing a crash helmet (p=0.016), driving while exhausting (p<0.001), talking with other passengers (p<0.001), being fined by the police in the past year (p=0.028), and maneuvering while driving (p<0.001) were related to a higher mean of ADHD score.

Conclusion

All RDBs were significantly associated with the ADHD score among motorcyclists in Iran. In this regard, health care providers should inform people with ADHD about the negative consequences associated with driving and ADHD. Public health policymakers should consider management of ADHD through a comprehensive approach to improve driving performance and competencies among motorcyclists in order to decrease RDBs and traffic accidents.

Adult ADHD screening scores and hospitalization due to pedestrian injuries: a case-control study

BACKGROUND

The aim of this study was to investigate the association between adult ADHD screening scores and hospitalization due to pedestrian injuries in a sample of Iranian pedestrians.

METHODS

Through a case-control study, a case population of 177 pedestrians injured by the vehicles in road traffic crashes were compared with 177 controls who lacked a record of intentional or unintentional injuries enrolled from various wards of Imam Reza University Hospital which is a specialty teaching hospital located in the same city with similar referral level. The cases and controls had an age range of 18-65 years and were matched on gender and age. ADHD symptom profile was assessed using the Persian Self-report Screening Version of the Conner's Adult ADHD Rating Scales (CAARS-S:SV). The association of ADHD screening score and pedestrian injuries was investigated using multiple binary logistic regression to investigate the independent effect of ADHD index score on belonging to case group. Both crude and adjusted odds ratios were reported.

RESULTS

Men comprised 86.4% of the study subjects. The crude odds ratios for all the four ADHD subscales to be associated with pedestrian injuries were 1.05, 1.08, and 1.04 for the subscales A (attention deficit), B (hyperactivity/impulsiveness) and ADHD index respectively. However, the association for subscale A was not statistically significant with a borderline p-value. The final multivariate analysis showed that variables associated with pedestrian injuries in the road traffic crashes were ADHD Index score (OR = 1.06, 95% CI: 1.01-1.12); economic status (including household income and expenditure capacity); educational level and total walking time per 24 h.

CONCLUSIONS

Adult ADHD screening score can predict pedestrian injuries leading to hospitalization independently from sex, age, economic status, educational level and pedestrian exposure to traffic environment (average walking time).

Understanding motorcyclist-related accidents in Colombia

In 2016, Colombia's position regarding motorcyclist fatalities per 100,000 inhabitants was tenth worldwide and second in South America. In the seven years from 2012-2018, the proportion of deceased and injured motorcyclists among all road users was 50%. To analyse the significant aspects of the accident rate of motorcyclists in Colombia from 2016 to 2018 and estimate cost social value of motorcycle-related deaths. The global numbers of fatalities and injuries were compared to the Colombian context. Descriptive and inferential statistics were conducted to explore the association of fatal trauma and motorcycle accidents. P values and odds ratios were calculated. Bogotá, Cali, and Medellín were the cities with the most accidents. The month, day, time, age of the victims, and climatic conditions had a statistically significant association with the fatal trauma. Most victims were between the ages of 20-29 years. Motorcycles were involved in more than 60% of accidents. The social cost of a life lost in a motorcycle accident was estimated at $2,418 million Colombian pesos (725,400 USD) per year. The establishment of countermeasures for the road safety of vulnerable users should focus on associated causal factors in order to develop strategies to effectively reduce the number of accidents.

Meta-analysis of the correlation between personality characteristics and risky driving behaviors

BACKGROUND

A systematic review and meta-analysis was performed to determine the relationships risky driving behaviors (RDBs) have with the big five personality factors, sensation seeking and driving anger.

METHODS

The PubMed, EMBASE, Web of Science, Scopus, Psychinfo, and the Cochrane Library databases were systematically searched. All original studies were retrieved that assessed the relationships RDBs had with the big five personality factors, sensation seeking, and driving anger. Heterogeneity between studies was examined using the Cochran Q statistic and I2 tests. After applying Fisher's r-to-z transformation, the correlation coefficients (r) were summarized from each study and 95% confidence intervals (CIs) were estimated.

RESULTS

Overall, 22 studies were included in the meta-analysis, which included 11211 participants. The results showed that RDBs had a significant negative relationship with agreeableness (r -0.27; 95% CI, -0.36, -0.19; P less than 0.0001), but significant positive relationships with neuroticism (r 0.16; 95% CI, 0.03, 0.29; P=0.584), sensation seeking (r 0.28; 95% CI: 0.23, 0.33; P less than 0.0001) and driving anger (r 0.39; 95% CI: 0.14, 0.64; P=0.002). Conversely, RDBs were not significantly related to extraversion (r -0.01; 95% CI, -0.08, 0.05; P=0.705), conscientiousness (r -0.05; 95% CI, -0.21, 0.12; P=0.584), or openness (r -0.06; 95% CI, -0.12, 0.00; P=0.065).

CONCLUSIONS

Therefore, it appears that individuals most likely to engage in risky driving behaviors would be low in agreeableness, but high in neuroticism, sensation seeking and driving anger.

Risk taking behaviors in relation to Attention Deficit and Hyperactivity Disorder in Iranian male workers: a latent class analysis

BACKGROUND

Risk taking behaviors are a serious risk to the health and safety of workers. The aims of this study were to identify the subgroups of workers on the basis of risk taking behaviors and assess the independent role of ADHD on the membership of participants in each latent class.

METHODS

This cross sectional study was performed on 2434 workers. The sample was selected through random cluster sampling from Kaveh Industrial City. All workers completed five sets of checklists and questionnaires. Data analysis was performed using chi-square, Fisher's exact test, and latent class analysis.

RESULTS

Four latent classes were identified; namely, 1) very low risk (65.6%), 2) low risk (27.8%), moderate risk (4.1%) and, high risk (2.5%). After adjusting for other studied covariates, having ADHD significantly increased the odds of membership in moderate risk class (OR=3.42, 95% CI: 2.21 -5.29) and high risk class (OR=3.10, 95% CI: 1.80 -5.34) compared to very low risk class. Also, having anxiety increased the odds of membership in latent class 2 (OR=1.28, 95% CI: 1.02-1.62), 3(OR=2.15, 95% CI: 1.51-3.10) and 4 (OR=2.06, 95% CI: 1.32-3.22) in comparison to class 1. Among all participants, 187 (7.7%) had ADHD and among studied variables, ADHD has the strongest role in the membership of subjects in different classes.

CONCLUSION

Results from the present study indicate that 6.6% of the workers fell under moderate or high risk class. Focusing on the treatment of ADHD with considering other comorbid factors such as anxiety may be helpful in designing and executing effective programs to reduce risk taking behaviors among workers.

Should Traffic Offenders Undergo Compulsory "Mental Test": A Study of Mental Health and Crash Involvement Among Commercial Motorcyclists in Ibadan, Nigeria?

Government policies on commercial motorcycle crash prevention are often not driven by data in terms of mental health risks. In this cross-sectional study, data was obtained from 508 commercial motorcyclists (CMs) in Ibadan, Nigeria on psychological distress, personality, suicidality, impulsivity, substance use and Intelligence Quotient, to determine the mental health correlates of road crash involvement. One-month and 12-month accident rates were 7.9 and 28.9% respectively. One-month crash involvement was independently associated with helmet non-use (OR 2.2, 95% CI 1.1-4.7, p = 0.03) and poor knowledge of road signs (OR 2.5, 95% CI 1.2-5.3, p = 0.02). The odds of 12-month crash involvement was increased among lifetime users of alcohol (OR 2.0, 95% CI 1.3-3.0, p = 0.001) and those with fewer than two children (OR 2.0, 95% CI 1.2-3.3, p = 0.006), but was reduced among riders with primary school education (OR 0.2, 95% CI 0.1-0.7, p = 0.007). Crash involvement rate in this population is high. Results from the study do not support routine psychiatric evaluation for traffic offenders, but are more in favour of safety education and traffic law enforcement.

The short Persian version of motorcycle riding behavior questionnaire and its interchangeability with the full version

The aim of current study was to develop a valid and reliable short motorcycle riding behavior questionnaire (SMRBQ) and assess its interchangeability with the original 48-item tool. Through a psychometric study in Bukan district of Iran in 2015, the most recent available Persian version of the motorcycle riding behavior questionnaire (MRBQ) was used as a reference to develop its short version, the SMRBQ. The preliminary version was prepared through expert reviews, and its dimension was further reduced through principal component analysis (PCA). An exploratory factor analysis (EFA) was then applied on the remaining items and the final version was developed with 23 items. The validity, consistency, agreement and interchangeability of the SMRBQ were assessed in parallel with the MRBQ using several statistical methods including Kendall’s Tau, intra-class correlation coefficient (ICC), Bland-Altman plot and receiver operating characteristics (ROC) curve analysis. All the 340 participants were males. The mean age of the participants was 30.2 (SD = 9.1). SMRBQ was developed including 23 items. The mean normalized score for the full version was 30.5 (SD = 11.2) and it was 30 (SD = 13.9) for the short version. There was a high correlation between the normalized scores of MRBQ and SMRBQ (Kendall’s Tau = 0.82). The ICC of the interchangeability of the full version and short version scales was as high as 0.92 (95% CI: 90.2–93.5). The scale had adequate internal consistency based on the calculated Cronbach’s alpha which was 0.85 for the scale. Bland-Altman and ROC curve analysis confirmed the interchangeability and criterion validity of the SMRBQ. The Persian version of SMRBQ was found to be a valid, reliable and feasible tool for assessing motorcycle riding behavior in the studied population.

Epidemiology of Traffic Fatalities among Motorcycle Users in East Azerbaijan, Iran

BACKGROUND

The aim of this study was to determine some epidemiological aspects of motorcycle user traffic fatalities including the crash mechanisms and injury patterns in East Azerbaijan, Iran (2006-2016).

METHODS

A total of 1840 motorcycle user mortal cases registered in East Azerbaijan forensic medicine database, in Iran, were analyzed over the time period between March 2006 and March 2016. The distribution and associations of both victim- and crash-related variables such as crash mechanism, types of involved vehicles, types of injuries, and demographic characteristics were investigated. Data were analyzed by Stata v.13 statistical software package.

RESULTS

Of the 9435 RTI deaths, 1840 (19.5%) were motorcycle users of whom 96.5% were male (mean age of 32.3 ± 18.5 years). The majority of accident mechanisms were motorcycle-vehicle crashes (77.8%), followed by rollover (11.8%). Cars were the leading counterpart crash vehicle comprising about 34.8% of the motorcycle user mortalities. Inner city traffic injuries were the reason for 744 (40.7%) of the motorcycle user mortalities. Head trauma was the main cause of death. About 82% of the victims were motorcycle riders and the remainder were pillion passengers. A decreasing trend of fatal traffic accidents was observed over the study period for both the motorcycle user fatalities and other traffic injuries. The percentage of motorcycle mortalities over all traffic mortalities had a decreasing trend over the past nine years from March 2007 to March 2016 reaching a figure as low as 15.2% through the last year of study.

CONCLUSIONS

Motorcycle traffic fatalities, although having a decreasing trend during the last decade with a better slope than most other traffic injuries, remain to be a major public health in north-west of Iran. There is a need for effective interventional programs to reduce the burden of motorcycle fatalities.

Evaluating the relationship between adult attention-deficit/hyperactivity disorder and riding behavior of motorcyclists

BACKGROUND

Motorcycling is one of the main causes of injury, and motorcyclists are vulnerable to road traffic injuries. Attention Deficit Hyperactivity Disorder (ADHD) in adults is presumably one of the determinants of road traffic injuries and motorcyclists' risky behavior. Despite the few studies on the relationship between motorcycle injuries and adult ADHD, their association has not been investigated using standardized instruments. This study aimed to analyze the relationship between motorcyclists' adult ADHD and risky riding behaviors.

METHODS

This community-based, cross-sectional study was performed on 340 motorcyclists in Bukan city, west Azerbaijan province, Iran in 2015 and 2016 using a cluster-random sampling in seven areas of the city. According to the city map used by Bukan's Health Centers, the city was divided into 14 clusters. Then, seven clusters (out of 14) were selected randomly. To reach the anticipated sample size, the data were collected from these seven clusters. In this study, the data collection instruments were: standard Motorcycle Rider Behavior Questionnaire (MRBQ), Conners' Adult ADHD Rating Scales (CAARS) questionnaire and a checklist designed by the researchers. The Stata 13 software package was used to analyze the collected data. Pearson correlation coefficient and multiple linear regression were performed to study the linear relationship between ADHD screening and MRBQ scores.

RESULTS

All 340 participants were male and the mean age was 30.2 years (SD=9.1). In addition, 22.1% of motorcyclists had a history of motorcycle crash. Bivariate analysis showed a significant association between risky riding behaviors and age, motorcycling records, and mean of riding hours per day (P-value less than 0.05). Multivariate analysis confirmed the correlation between ADHD and risky riding behaviors in all subscales (A, B, D) (p less than 0.05).

CONCLUSIONS

Those with a high ADHD screening score are more likely to have risky riding behaviors.

Predictive ability of underlying factors of motorcycle rider behavior: an application of logistic quantile regression for bounded outcomes

Background: The human factors are of great importance, especially Motorcycle Rider Behavior Questionnaire (MRBQ) and attention deficit hyperactivity disorder (ADHD) in motorbike riders in road traffic injuries. This study aimed to predict MRBQ score by ADHD score and the underlying predictors by the logistic quantile regression (LQR), as a new strategy.

Methods: In this cross-sectional study, 311 motorbike riders were randomly sampled by a clustering method in Bukan, northwest of Iran. The data were collected by MRBQ and ADHD standard surveys. To assess the relationship at all levels of MRBQ distribution, LQR in 5th, 25th, 50th, 75th and 95th quantiles of MRBQ score was utilized to assess the predictability of ADHDscore and its subscales in addition to the underlying predictors of MRBQ score. To do this, an unadjusted and as well as adjusted 4-step hierarchical modeling was used.

Results: Almost in all quantiles of MRBQ scores, direct and significant relationships were observed between MRBQ score and ADHD score and its subscales (coefficients: 0.02 to 0.10, all P < 0.05). Besides, the driving period (coefficients: -0.58 to -0.95, P < 0.05) and hour driving (coefficients: 0.42 to 0.52, P < 0.05) also came to be the significant predictors of MRBQ score.

Conclusion: ADHD score and driving parameters can be taken into the consideration when planning actions on the motorcycle rider behaviors at all levels of the MRBQ.

Age-related risk factors with nonfatal traffic accidents in urban areas in Maringá, Paraná, Brazil

OBJECTIVE

The present study aimed to analyze the factors associated with the occurrence of nonfatal traffic accidents regarding age.

METHODS

A retrospective, transversal, and analytical study was carried out in the municipality of Maringá, Paraná, Brazil, based on data from Boletins de Ocorrência de Acidente de Trânsito ("Police Occurrence Bulletins"; BOATs). Following probability sampling, the sociodemographic aspects, logistics, environmental conditions, and time of occurrence of 418 cases of accidents were analyzed. The age of the victims was considered to be the dependent variable. The data were analyzed using descriptive statistics and bivariate, multivariate, and variance analysis, considering a confidence interval of 95% and a significance level of 5% (P <.05).

RESULTS

Results revealed that young people (15-29 years) were twice as likely to be hospitalized due to severe injuries. Young motorcyclists had a 2.5 times greater chance of suffering accidents (P <.001); the use of other vehicles such as cars, bicycles, buses, and trucks represented a protective factor for this group (P <.05). Multiple logistic regression revealed that the main predictors for the occurrence of accidents were being single, having over 8 years of education, having had a driver's license for less than 3 years, roads with low luminosity, and driving at night.

CONCLUSIONS

Demographic, environmental, and logistical factors were associated with morbidity due to traffic accidents among young people. These results challenge society and policy makers to create more effective strategies to minimize this serious public health problem.

Epidemiological and Clinical Characteristics of Traumatic Hand and Finger Amputations in North Western Iran; A Single Center Experience

OBJECTIVE

To determine the epidemiological and clinical characteristics of hand and finger amputations in patients referring to a single center in northern Iran.

METHODS

This was a cross-sectional study conducted on 200 traumatic hand amputees hospitalized in Shohada Hospital in Tabriz, Northwestern Iran during a 1-year period in 2014. Data were collected through prospective interviews for variables such as demographic characteristics, accident time; exact anatomical site of amputation; reasons for amputation; amputation mechanism; and having attention deficit symptoms as well as activities causing attention deficit prior to the accident.

RESULTS

The vast majority of cases were men and women accounted for only 7.5% of injured cases. In 60.5% of cases, the accident occurred on the fingers of their active hand and fingers accounted for almost 95% of accidents. 85.8% of accidents occurred at work . 63.7% of accidents occurred in the evening. 63.67% of accidents occurred in the evening. Among hazardous occupations, agricultural occupations ranked the first followed by sugar cut and pressing jobs. It was found that 10% of the victims were injured while responding a mobile phone call and 3% of the victims reported that they were listening to music through headphones before the accident.  Five percent of the participants reported a quarrel with a colleague and 11.5 % of them reported a quarrel with their employer prior to the accident.

CONCLUSION

Amputations are of much importance in men working in given jobs such as agricultural and pressing. Distraction caused by mobiles, music and personal relations with others is considered of importance to be prevented during job. Risk levels for potential risk indicators need to be assessed through controlled studies.

Attention deficit/hyperactivity disorder and risk of injuries: A systematic review and meta-analysis

Background:

This study systematically reviewed the literature in order to determine the effect of Attention-Deficit Hyperactivity Disorder (ADHD) on injuries and assessed the magnitude of the potential association.

Methods:

A systematic review of the studies examining the association of ADHD and injuries was carried out across multiple databases. Odds ratios and standardized mean differences were pooled.

Results:

A total of 35 studies were selected for quantitative analysis. The association of ADHD and injuries was confirmed over the meta-analysis of eligible studies. The odds ratio pooled over all comparative studies was 1.96(95% CI: 1.6-2.4) using random effects model. Pooled odds ratio of 2.1 and 2.17 were calculated respectively when cohort and case-control studies or just cohort studies were included. The pooled odds ratio reduced to 1.8(CI:1.45-2.3) when studies on specific injuries were removed. For studies comparing scores of rating scales, the pooled standardized mean difference was 0.61(95% CI: 0.03-1.2).

Conclusions:

Those with ADHD are nearly two times more likely to be injured.