Global Incidence and Mortality Patterns of Pedestrian Road Traffic Injuries by Sociodemographic Index, with Forecasting: Findings from the Global Burden of Diseases, Injuries, and Risk Factors 2017 Study

Estimating the effectiveness of marked sidewalks: An application of the spatial causality approach

Various safety enhancements and policies have been proposed to enhance pedestrian safety and minimize vehicle-pedestrian accidents. A relatively recent approach involves marked sidewalks delineated by painted pathways, particularly in Asia's crowded urban centers, offering a cost-effective and space-efficient alternative to traditional paved sidewalks. While this measure has garnered interest, few studies have rigorously evaluated its effectiveness. Current before-after studies often use correlation-based approaches like regression, lacking effective consideration of causal relationships and confounding variables. Moreover, spatial heterogeneity in crash data is frequently overlooked during causal inference analyses, potentially leading to inaccurate estimations. This study introduces a geographically weighted difference-in-difference (GWDID) method to address these gaps and estimate the safety impact of marked sidewalks. This approach considers spatial heterogeneity within the dataset in the spatial causal inference framework, providing a more nuanced understanding of the intervention's effects. The simplicity of the modeling process makes it applicable to various study designs relying solely on pre- and post-exposure outcome measurements. Conventional DIDs and Spatial Lag-DID models were used for comparison. The dataset we utilized included a total of 13,641 pedestrian crashes across Taipei City, Taiwan. Then the crash point data was transformed into continuous probability values to determine the crash risk on each road segment using network kernel density estimation (NKDE). The treatment group comprised 1,407 road segments with marked sidewalks, while the control group comprised 3,097 segments with similar road widths. The pre-development program period was in 2017, and the post-development period was in 2020. Results showed that the GWDID model outperformed the spatial lag DID and traditional DID models. As a local causality model, it illustrated spatial heterogeneity in installing marked sidewalks. The program significantly reduced pedestrian crash risk in 43% of the total road segments in the treatment group. The coefficient distribution map revealed a range from -22.327 to 2.600, with over 95% of the area yielding negative values, indicating reduced crash risk after installing marked sidewalks. Notably, the impact of crash risk reduction increased from rural to urban areas, emphasizing the importance of considering spatial heterogeneity in transportation safety policy assessments.

Prediction of the burden of road traffic injuries in Iran by 2030: Prevalence, death, and disability-adjusted life years

PURPOSE

Road traffic accidents pose a global challenge with substantial human and economic costs. Iran experiences a high incidence of road traffic injuries, leading to a significant burden on society. This study aims to predict the future burden of road traffic injuries in Iran until 2030, providing valuable insights for policy-making and interventions to improve road safety and reduce the associated human and economic costs.

METHODS

This analytical study utilized time series models, specifically autoregressive integrated moving average (ARIMA) and artificial neural networks (ANNs), to predict the burden of road traffic accidents by analyzing past data to identify patterns and trends in Iran until 2030. The required data related to prevalence, death, and disability-adjusted life years (DALYs) rates were collected from the Institute for Health Metrics and Evaluation database and analyzed using R software and relevant modeling and statistical analysis packages.

RESULTS

Both prediction models, ARIMA and ANNs indicate that the prevalence rates (per 100,000) of all road traffic injuries, except for motorcyclist road injuries which have an almost flat trend, remaining at around 430, increase by 2030. Based on estimations of both models, the rates of death and DALYs due to motor vehicle and pedestrian road traffic injuries decrease. For motor vehicle road injuries, estimated trends decrease to approximately 520 DALYs and 10 deaths. Also, for pedestrian road injuries these rates reached approximately 300 DALYs and 6 deaths, according to the models. For cyclists and other road traffic injuries, the predicted DALY rates by the ANN model increase to almost 50 and 8, while predictions conducted by the ARIMA model show a static trend, remaining at 40 and approximately 6.5. Moreover, these rates for the prediction of death rate by the ANN model increased to 0.6 and 0.1, while predictions conducted by the ARIMA model show a static trend, remaining at 0.43 and 0.07. According to the ANN model, the predicted rates of DALY and death for motorcyclists decrease to 100 and approximately 2.7, respectively. On the other hand, predictions made by the ARIMA model show a static trend, with rates remaining at 200 and approximately 3.2, respectively.

CONCLUSION

The prevalence of road traffic injuries is predicted to increase, while the death and DALY rates of road traffic injuries show different patterns. Effective intervention programs and safety measures are necessary to prevent and reduce road traffic accidents. Different interventions should be designed and implemented specifically for different groups of pedestrians, cyclists, motorcyclists, and motor vehicle drivers.

Road traffic mortality in Iran: longitudinal trend and seasonal analysis, March 2011-February 2020

Road traffic mortalities (RTMs) and injuries are among the leading causes of human fatalities worldwide, particularly in low-and middle-income countries like Iran. Using an interrupted time series analysis, we investigated three interventional points (two government-mandated fuel price increases and increased traffic ticket fines) for their potential relation to RTMs. Our findings showed that while the overall trend of RTMs was decreasing during the study period, multiple individual provinces showed smaller reductions in RTMs. We also found that both waves of government-mandated fuel price increases coincided with decreases in RTMs. However, the second wave coincided with RTM decreases in a smaller number of provinces than the first wave suggesting that the same type of intervention may not be as effective when repeated. Also, increased traffic ticket fines were only effective in a small number of provinces. Potential reasons and solutions for the findings are discussed in light of Iran's Road Safety Strategic Plan.

Burden of road traffic injuries in Iran: a national and subnational perspective, 1990-2019

OBJECTIVES

Reliable and valid information on burden of road traffic injuries (RTIs) is essential for short-term and long-term planning. We designed the present study to describe the levels and trends of burden of RTIs in Iran from 1990 to 2019.

METHODS

This is an observational epidemiological study. We used the Global Burden of Disease (GBD) 2019 estimates to report RTIs incidence, prevalence, mortality and disability-adjusted life-years (DALYs) by sex, age group and road user category in Iran and each of the 31 provinces from 1990 to 2019.

RESULTS

Age-standardised incidence, prevalence, death and DALY rates of RTIs decreased by 31.7% (95% uncertainty interval (UI): 29.4 to 33.9), 34.9% (33.8 to 36.0), 57.7% (48.1 to 62.3) and 60.1% (51.7 to 65.2), respectively between 1990 and 2019. The 2019 age-standardised DALY rates varied from smallest value in Tehran 303.8 (216.9 to 667.2) per 100 000 to largest value in Sistan-Baluchistan 2286.8 (1978.1 to 2627.9) per 100 000. The burden of RTIs was mainly related to injuries sustained by drivers or passengers of motorised vehicles with three or more wheels and pedestrians' injuries, mostly affected males aged 15-29 years and individuals aged ≥70 years.

CONCLUSION

The reducing trend in the burden of RTIs in Iran possibly reflects the effectiveness of the intervention programmes. However, with regard to the Sustainable Development Goals the burden is still at an alarming level. Further reductions are necessary for specific road user groups such as adolescent and adult male drivers or passengers of motorised vehicles, also pedestrians aged ≥70 years.

Pedestrian injuries in collisions with pedal cycles in the context of increased active travel: Trends in England, 2005-2015

INTRODUCTION

Increasing levels of active travel in the population brings many public health benefits, but may also change the risks of road injury for different road users. We examined changes in rates of pedestrian injuries resulting from collisions with pedal cycles and motor vehicles in England during 2005-2015, a period of increased cycling activity, and described the gender, age distribution and locations of pedestrians injured in collisions with pedal cycles and motor vehicles.

METHODS

Collisions data were obtained from police STATS19 datasets. We used two measures of cycle/motor vehicle use; miles per annum, and estimated average travel time, and assessed evidence for trends towards increase over time using Poisson regression analysis.

RESULTS

There were 3414 pedestrians injured in collisions with one or more pedal cycles in England during 2005-2015, 763 of whom were killed or seriously injured (KSI). This accounted for 1.3% of the total pedestrians KSI from all vehicles. Of those KSI in collisions with cycles, 62% were female; 42% over the age of 60; 26% were on the footway or verge and 24% were on a pedestrian crossing. There was a 6% (IRR 1.056; 95% CI 1.032-1.080, p < 0.001) annual increase in the pedestrian KSI rate per billion vehicle miles cycled in England over the time span. This increase was disproportionate to the increase in cycle use measured by vehicle miles or time spent cycling.

CONCLUSIONS

Increases in cycling were associated with disproportionate increases in pedestrian injuries in collisions with pedal cycles in England, although these collisions remain a very small proportion of all road injury. Increased active travel is essential for meeting a range of public health goals, but needs to be planned for with consideration for potential impact on pedestrians, particularly older citizens.

The 2019 Conference on Health and Active Transportation: Research Needs and Opportunities

Active transportation (AT) is widely viewed as an important target for increasing participation in aerobic physical activity and improving health, while simultaneously addressing pollution and climate change through reductions in motor vehicular emissions. In recent years, progress in increasing AT has stalled in some countries and, furthermore, the coronavirus (COVID-19) pandemic has created new AT opportunities while also exposing the barriers and health inequities related to AT for some populations. This paper describes the results of the December 2019 Conference on Health and Active Transportation (CHAT) which brought together leaders from the transportation and health disciplines. Attendees charted a course for the future around three themes: Reflecting on Innovative Practices, Building Strategic Institutional Relationships, and Identifying Research Needs and Opportunities. This paper focuses on conclusions of the Research Needs and Opportunities theme. We present a conceptual model derived from the conference sessions that considers how economic and systems analysis, evaluation of emerging technologies and policies, efforts to address inclusivity, disparities and equity along with renewed attention to messaging and communication could contribute to overcoming barriers to development and use of AT infrastructure. Specific research gaps concerning these themes are presented. We further discuss the relevance of these themes considering the pandemic. Renewed efforts at research, dissemination and implementation are needed to achieve the potential health and environmental benefits of AT and to preserve positive changes associated with the pandemic while mitigating negative ones.

Systematic Literature Review of Walkability and the Built Environment

Walking is the most sustainable form of transportation. It is the socially equitable, economically viable and environmentally friendly mode of transportation. However, transportation technology has caused the desertion of the pedestrian space due to excessively motorized transport. Consequently, the pedestrian environment has degraded. In many cities, the abandonment of the pedestrian space has created a socially unfriendly environment. Walkability is a measure of how friendly an area is to walk. In measuring walkability, several criteria are considered, which include inter alia, the quality of pedestrian facilities, roadway conditions, land use patterns, community support, security and comfort for walking. Findings from studies are mixed; some stated that improving the built environment does not encourage people to walk more; however, there are other studies that indicated otherwise. The aim of this paper is to review the built environment characteristics that promote walking. A literature review of studies that focused on walking, walkability, the built environment, pedestrian and urban design was conducted. This study has searched the electronic databases that intertwined with the Web of Science database. The choice was made due to the comprehensiveness of quality academic studies indexed in the database, thus providing reliable sources of body of work. The database integrates numerous sub-databases such as Web of Science Core Collection, Derwent Innovations Index, KCI Korean Journal Database, Russian Science Citation Index and SciELO Citation Index. The data are then thematically coded. The fields of urban planning, urban design, geography, transportation, sociology, and other related areas were included in the research. The result of this review offers evidence to the criteria that promote walking. The review found that three criteria are somewhat constant in promoting walking, namely, population and building density, land use and land use mixes, and safety. In short, by making an area perceived as safe with the presence of land use mixes and density are the best combination to create a walkable environment.

Road injury burden in Mexico 1990 to 2019: Secondary data analysis from the Global Burden of Disease Study

Road injuries have been a major cause of premature mortality and disability in Mexico. The objective of this paper is to report the findings from the Global Burden of Disease study (GBD-2019) on road injuries in Mexico at a national and subnational scale from 1990 to 2019, and to assess the association between road injury burden and the socio-demographic index. Following the 2019 Global Burden of Disease study road injury mortality, premature mortality, the years lived with disability and disability-adjusted life-years (DALYs) are reported. While the number of deaths from road injuries increased between 1990 and 2019, the age-standardized mortality rates declined. Pedestrian road injuries and motor vehicle road injuries accounted for 8 of every 10 deaths from road injury in 2019. Road injury mortality and DALY rates decreased nationally, but stagnated since 2011. The road injury burden was higher for men in all age groups. Pedestrian and motor vehicle road injuries caused the highest DALY rate in both males and females. There was no significant association between the SDI and the road injury age-standardized DALY rates. This study presents a comprehensive report of road injury burden of disease in Mexico. Mexico continues to have an incomplete, fragmented and poorly enforced legislative framework, with a large diversity between its 32 states. Thus, an integrated legislative and juridical effort is needed to continue reducing the road injury disease burden, which is tailored for specific age groups, vulnerable road users and high-burden areas.

Global, Regional, and National Burden of Myocarditis From 1990 to 2017: A Systematic Analysis Based on the Global Burden of Disease Study 2017

Objective: The global trends in myocarditis burden over the past two decades remain poorly understood and might be increasing during the coronavirus disease 2019 (COVID-19) worldwide pandemic. This study aimed to provide comprehensive estimates of the incidence, mortality, and disability-adjusted life years (DALYs) for myocarditis globally from 1990 to 2017.

Methods: Data regarding the incidence, mortality, DALY, and estimated annual percentage change (EAPC) between 1990 and 2017 for myocarditis worldwide were collected and calculated from the 2017 Global Burden of Disease study. We additionally calculated the myocarditis burden distribution based on the Socio-Demographic Index (SDI) quintile and Human Development Index (HDI).

Results: The incidence cases of myocarditis in 2017 was 3,071,000, with a 59.6% increase from 1990, while the age-standardized incidence rate (ASIR) was slightly decreased. The number of deaths due to myocarditis increased gradually from 27,120 in 1990 to 46,490 in 2017. The middle SDI quintile showed the highest number of myocarditis-related deaths. On the contrary, the global age-standardized death rate (ASDR) decreased with an overall EAPC of −1.4 [95% uncertainty interval (UI) = −1.8 to −1.0]. Similar to ASDR, the global age-standardized DALY rate also declined, with an EAPC of −1.50 (95% UI = −2.30 to −0.8) from 1990 to 2017. However, there was a 12.1% increase in the number of DALYs in the past 28 years; the middle SDI and low-middle SDI quintiles contributed the most to the DALY number in 2017. We also observed significant positive correlations between the EPAC of age-standardized rate and HDI for both death and DALY in 2017.

Conclusions: Globally, the ASIR, ASDR, and age-standardized DALY rate of myocarditis decreased slightly from 1990 to 2017. The middle SDI quintile had the highest level of ASIR, ASDR, and age-standardized DALY rate, indicating that targeted control should be developed to reduce the myocarditis burden especially based on the regional socioeconomic status. Our findings also provide a platform for further investigation into the myocarditis burden in the era of COVID-19.

Secular Trend, Seasonal Variation, Epidemiological Pattern, and Outcome of Traumatic Head Injuries Due to Road Traffic Accidents in Aseer, Saudi Arabia

Road traffic accidents (RTAs) are a leading cause of traumatic head injury (THI) and are regarded as a public health problem in Saudi Arabia. This hospital-based retrospective study aims to provide data on the frequency, type, and distribution of RTA-related THIs over the past decade; demonstrate their time trend and seasonality; and decipher age and sex differences in RTA-related THIs and their outcome. The results showed a decline in the number of RTA-related THIs between 2010 and 2019. The patients had a mean age of 26.16 ± 16.27 years, and the male-to-female ratio was 10.8:1. Head injury with multiple lesions was the most common diagnosis, followed by cerebral contusion and skull fracture (32.1%, 12.9%, and 11.2%, respectively). Subdural hematoma (SDH) and skull fracture were significantly more common in patients aged ≥60 years (standard residual > 1.96), and significantly less common in those aged ≤17 years (standard residual < 1.96), compared to other age groups. Males experienced significantly more SDHs than females (standard residual = −2.8, p = 0.029). The length of hospital stay was positively correlated with age (Spearman’s rho = 0.057, p = 0.046). No seasonal variation was found.

Analysis of Pedestrian–Motor Vehicle Crashes in San Antonio, Texas

Pedestrian safety is becoming a global concern and an understanding of the contributing factors to severe pedestrian crashes is crucial. This study analyzed crash data for San Antonio, TX, over a six-year period to understand the effects of pedestrian–vehicle crash-related variables on pedestrian injury severity based on the party at fault and to identify high-risk locations. Bivariate analysis and logistic regression were used to identify the most significant predictors of severe pedestrian crashes. High-risk locations were identified through heat maps and hotspot analysis. A failure to yield the right of way and driver inattention were the primary contributing factors to pedestrian–vehicle crashes. Fatal and incapacitating injury risk increased substantially when the pedestrian was at fault. The strongest predictors of severe pedestrian injury include the lighting condition, the road class, the speed limit, traffic control, collision type, the age of the pedestrian, and the gender of the pedestrian. The downtown area had the highest crash density, but crash severity hotspots were identified outside of the downtown area. Resource allocation to high-risk locations, a reduction in the speed limit, an upgrade of the lighting facilities in high pedestrian activity areas, educational campaigns for targeted audiences, the implementation of more crosswalks, pedestrian refuge islands, raised medians, and the use of leading pedestrian interval and hybrid beacons are recommended.

Nucleic acid analysis on paper substrates (NAAPs): an innovative tool for Point of Care (POC) infectious disease diagnosis

The cost-effective rapid diagnosis of infectious diseases is an essential and important factor for curing such diseases in the global public health care picture. Owing to poor infrastructure and lack of sanitation, these diseases have an extreme impact on remote and rural areas, especially in developing countries, and there are unresolved challenges. Molecular diagnosis, such as nucleic acid analysis, plays a key role in the significant treatment of numerous infectious diseases. Current molecular diagnostic assays require a sophisticated laboratory setup with expensive components. Molecular diagnosis on a microfluidic point-of-care (POC) platform is attractive to researchers for disease detection with proper prevention. Compared to various microfluidic substrate materials, paper-based POC technologies offer significant cost-effective solutions over high-cost clinical instruments to fill the gap between the needs of users and affordability. Low-cost paper-based microfluidic POC technologies provide portable and disposable diagnostic systems for multiple disease detection that may be extremely useful in remote areas. This article presents a critical review of paper-based microfluidic device technology which has become an imminent platform to adjust the current health scenario for the detection of diseases using different stages of nucleic acid analysis, such as extraction, amplification and detection of nucleic acid, with future perspectives for paper substrates.

Risk factors associated with quad bike crashes: a protocol for systematic review of observational studies

INTRODUCTION

Quad bikes are four-wheeled vehicles, driven off-road on uneven terrains by farmers for work or young adults for leisure. Quad bike accidental crashes result mostly due to the unique ecosystem of uneven terrain, where these unstable vehicles are commonly driven, in addition to numerous distinctive sociodemographic characteristics related to drivers. This is a protocol for a systematic review of observational studies from all geographical regions and demographic groups in the world to summarise the common risk factors relating to quad bike crashes.

METHODS AND ANALYSIS

A comprehensive search for the literature on quad bike crashes and related injuries will be conducted in six electronic databases: PubMed, Embase, Scopus, Web of Science, IEEE and PsycINFO. Proquest Dissertation and Thesis, OpenGrey and BASE will be searched for grey literature. Five researchers will be involved in the screening, and the review of full text articles, using the inclusion and exclusion criteria. Disagreements between reviewers will be resolved by discourse. Three researchers will help resolving conflicts that may arise during the screening process and will resolve eventual conflicts identified in the process with the help of the systematic review software 'Covidence' for automatic deduplication and blinded screening. Information on crashes leading to injuries and death, target population characteristics and risk factors involved will be extracted from eligible articles in addition to the assessment of the quality of the researched articles.

ETHICS AND DISSEMINATION

Since this is a systematic review of published literature, a formal ethical approval is not needed. Results of the review will be disseminated through peer-reviewed publications, conference presentations and reports to the concerned authorities.

PROSPERO REGISTRATION NUMBER

CRD42020170245.

Not gendered… but different from each other? A structural equation model for explaining risky road behaviors of female and male pedestrians

As alternative transportation is getting more and more fashionable, and more people worldwide are "shifting" to walking trips, even for their daily commuting, traffic crashes suffered by pedestrians are still a great concern for road safety and public health researchers and practitioners. In this regard, risky or "aberrant" road behaviors have emerged, during the last few years, as a key issue to be considered for crash prevention. Nevertheless, the idea of a "generic pedestrian" is getting re-evaluated, and analyzing key features, such as gender, seems to be crucial for understanding pedestrians' performance and safety outcomes.

OBJECTIVE

The objective of this study was to examine the effect of gender on pedestrians' both deliberate (traffic violations) and undeliberate (errors) risky walking behaviors, considering a set of theoretically based demographic and psychosocial variables as their potential predictors.

METHOD

For this cross-sectional study, data from 1070 Spanish pedestrians (60 % females and 40 % males, aged between 16 and 79) from the 17 regions of Spain, responding to an electronic questionnaire, were analyzed through a multi-group structural equation modeling (MGSEM) approach.

RESULTS

Although age, handheld device-interaction, and sensation-seeking seem to have a similar effect on the errors and violations reported by both genders (similarities), factors such as risk perception, educational level and the misbehaviors observed in other road users are significant predictors only in the case of male pedestrians. On the other hand, road distractions have been shown to play a significant role in females' errors and violations, while males' road distractions seem to only affect their involuntary risky behaviors.

CONCLUSION

The findings of this study support the influence of gender in the statistical explanation of both deliberate and undeliberate walking risky road behaviors, also depicting the differential role of certain demographic and psychosocial factors when we compare male and female pedestrians.

Knowledge, Practice, and Associated Factors of Nurses in Pre-Hospital Emergency Care at a Tertiary Care Teaching Hospital

BACKGROUND

Pre-hospital emergency care is a medical care given to patients before arrival in the hospital after activation of the emergency team. Poor knowledge and practice about pre-hospital emergency care hurt the health outcomes of the patients.

OBJECTIVE

This study aimed to assess knowledge and practice nurses at the University of Gondar Compressive Specialized Hospital, Northwest Ethiopia.

METHODS

An institutional-based cross-sectional study was conducted from March 20 to April 10, 2020. A stratified sampling technique was used to select the study participants. Data were collected using a pretested structured self-administered questionnaire. Data were analyzed using SPSS version 20. To explain study variables, frequency tables and percentages were used. Logistic regression analysis was used to see the association between independent and dependent variables.

RESULTS

Out of the total 378 respondents, less than half (42.9%) had good knowledge; similarly, 49.5% of them had good practice about pre-hospital emergency care. Male sex and attend formal training were significant associations with both knowledge and practice of pre-hospital emergency nursing care. Male participants (adjusted odds ratio (AOR) = 6.57, 95% confidence interval (CI) (3.79-11.36)) and having training (AOR=1.74, 95% CI (1.83-3.66)) were significantly associated with knowledge of pre-hospital emergency care, whereas male sex (AOR=1.73, 95% CI (1.09-2.73)) and having training (AOR=6.16, 95% CI (2.69-14.10)) were significantly associated with the practice of pre-hospital emergency care.

CONCLUSION

Knowledge and practice of nurses regarding pre-hospital emergency care was found to be inadequate as compared to previous studies. Male sex and attend formal training showed a positive and significant association with both knowledge and practice of pre-hospital emergency nursing care. The responsible body ought to allow professional development and attending formal training for nurses.

Financing of physical rehabilitation services in Iran: a stakeholder and social network analysis

Background

Inadequate financing is one of the major barriers in securing equitable access to high-quality physical rehabilitation services, without imposing financial hardship. Despite this, no sufficient attention has been paid to physical rehabilitation services and no specific financial resources have been allocated to such services in many countries including Iran. Owing to the fact that effective decision- and policy-making requires identifying possible stakeholders and actors and their characteristics, in the current study a stakeholder analysis and also a social network analysis (SNA) was conducted to identify the potential stakeholders and also their characteristics involved in physical rehabilitation financing (PRF)-related policies in Iran.

Methods

The present study was performed in two phases. Firstly, semi-structured interviews and relevant document review were conducted to identify the stakeholders. Then, the position, power, interest, and influence of each stakeholder were determined using a web-based questionnaire. Secondly, SNA approach was utilized to map and visualize the interactions among stakeholders.

Results

The findings showed that there are different stakeholders in PRF-related decision- and policy-making processes in Iran. In addition, the position, power, interest, and influence level of the identified stakeholders were varied. Moreover, although some stakeholders, like the Ministry of Health and the parliament have the highest level of power and position, they lack sufficient interest to participate in PRF-policies. Furthermore, SNA demonstrated that social network density was low, which indicates the lack of proper collaboration and interaction among the stakeholders.

Conclusion

As many powerful and influential stakeholders had low interest levels to warrant participate in the FPR-related decision- and policy-making processes in Iran, employing careful and effective strategies, that is ongoing negotiations, receiving advocacy, and making senior managers and policy-makers aware can be helpful.