Epidemiological Patterns of Road Traffic Crashes During the Last Two Decades in Iran: A Review of the Literature from 1996 to 2014

Factors influencing the road accidents in low and middle-income countries: a systematic literature review

This paper studies the main factors affecting road traffic accidents (RTAs) using a systematic review. The primary focus is on factors related to road characteristics and driver behaviours. This review also addresses the socioeconomic and demographic factors to provide a clear overview of which groups suffer the most from RTAs. Several factors were found to affect RTAs, notably road characteristics: highways, high-speed roads, unplanned intersections and two-way roads without dividers; driver behaviours: reckless/aggressive driving and riding, excessive speeding, unawareness of traffic laws, and not using safety equipment; and vehicle types: four and two-wheeled. This review found that male and economically productive people with less education were mostly associated with RTAs. In addition, for most of the low and middle-income countries analyzed, there is a lack of quality data relating to RTAs. Nevertheless, this review provides researchers and policy makers with a better understanding of road accidents for improving road safety.

Epidemiology of Traumatic Brain Injury in Iran: A Systematic Review and Meta-Analysis

Background

Traumatic brain injury (TBI) is one of leading cause of death and disability in Iran that has serious consequences on people's health. Understanding of epidemiology of TBI can be helpful for policy making in health care management. Therefore, this study aimed to examine the epidemiology of TBI in Iran.

Methods

PubMed, Web of Science, Scopus, Google scholar, and internal databases including, SID, Magiran, and IranMedex were searched to identify the relevant published studies up to Feb 2022. Moreover, the references list of key studies was scanned to find more records. The Joanna Briggs Institute (JBI) tool was used to assess the quality of included studies. The Excel and Comprehensive Meta-Analysis software were to analyze the data.

Results

Overall, 23,446 patients from 15 studies were included in the study. The overall mean age of the patients was 31.36 ± 0.13 yr (95%CI: 31.10 to 31.61). The majority of the patients were male (74.37%), with a male to female ratio of 3:1. The incidence rate of TBI was 15.3 to 144 per 100,000 population. The mortality rate of TBI was estimated to be 10.4% (95%CI: 5% to 19%). The most common causes of injury were road traffic accidents (RTAs) (60%; 95%CI: 49% to 70%), and falling (20%; 95%CI: 16% to 26%), respectively. The most frequent type of head injury was subdural hematoma.

Conclusion

Our findings highlight that appropriate control and prevention strategies should be focused on male, road traffic accidents, and the group under 40 yr.

Adaptation of a European categorization system for driving-impairing medicines in Iran

OBJECTIVE

Road traffic crashes due to impaired driving are a leading cause of preventable injuries and deaths. The purpose of this study was adaptation of a European categorization system for driving-impairing medicines in Iran.

METHODS

DRUID categorization system was used as a leading model to classify medicines. Medicines that were compatible with DRUID categorization system were identified and classified accordingly. Medicines that were not compatible with DRUID categorization system were assessed in an expert panel in terms of possiblity of classification. Instructions for health care providers and advice for patients were prepared based on the medicine's influence on fitness to drive.

RESULTS

Of the 1255 medicines in Iranian pharmacopeia, 488 medicines were classified in four categories. Among classified medicines 43.85% and 25.41% belonged to Category 0 and Category 1. About 13.94%, 10.04%, and 6.76% pertained to Category 2, Category 3, and Multiple categories respectively. Majority of the medicines with moderate and severe adverse influences on driving fitness belonged to the nervous system medicines (72.65%). Most of the medicines with non-existing or minor adverse influences on driving fitness pertained to cardiovascular medicines (16.56%). Majority of uncategorized medicines belonged to Iranian herbal medicines.

CONCLUSION

The current study disclosed that DRUID categorization system was implementable for most of the commonly prescribed medicines. Experimental studies are needed to determine the influence of uncategorized medicines of Iranian pharmacopeia. Other countries with similar settings can adapt DRUID categorization system until they develop their own model using original studies.

Factors affecting the number of road traffic accidents in Kerman province, southeastern Iran (2015-2021)

Road traffic accidents (RTAs) are among the top causes of mortality and disability globally, particularly in developing nations like Iran. In this study, RTAs were analyzed to develop precise predictive models for predicting the frequency of accidents in the Kerman Province (southeastern Iran) using the autoregressive integrated moving average (ARIMA) and autoregressive integrated moving average with explanatory variables (ARIMAX) modeling methods. The findings demonstrate that including factors regarding humans, vehicles, and elements of nature in the time-series analysis of accident records resulted in the development of a more reliable prediction model than utilizing only aggregated accident count. The understanding of safety on the road is increased by this research, which also offers a method for forecasting that utilizes a variety of parameters relating to people, cars, and the environment. The findings of this research are likely to contribute to lowering the incidence of RTAs in Iran.

Exploring the Causal Impact of Age and Nighttime Driving on Road Traffic Injuries among Elderly Drivers: A Bayesian LASSO Approach

Objective

To determine the causal relationship between aging and nighttime driving and the odds of injury among elderly drivers.

Methods

In this cross-sectional study, 5460 car accidents were investigated from 2015 to 2016. The data were extracted from the Iranian Integrated Road Traffic Injury Registry System. Pedestrian accidents, motorcycle crashes, and fatalities were excluded from the study. To account for major confounders, Bayesian-LASSO, and treatment-effect cutting-edge approaches were used.

Results

Overall, 801 injuries (14.67%) were evaluated. The results of the univariable analysis indicated that aging and nighttime had adverse effects on the odds of road traffic injuries (RTIs), even after adjusting for the effect of other variables, these effects remained statistically significant. According to a newly developed approach, the overall effects of aging and nighttime were significantly and directly correlated with the odds of being injured for older adults (both p<0.001). Our findings indicated that drivers over 75 years old experienced 23% higher injury odds (OR=1.23, 95% CI:1.11 to 1.39; p<0.001), while driving at night increased the odds by 1.78 times (OR=1.78, 95% CI:1.51 to 1.83; p<0.001).

Conclusion

Aging and nighttime driving are significant risk factors for RTIs among elderly drivers. This highlights the importance of implementing targeted interventions to enhance road safety for this vulnerable population. Furthermore, the use of advanced Bayesian-LASSO and treatment-effect statistical methods highlights the importance of utilizing sophisticated methodologies in epidemiological research to effectively capture and adjust for potential confounding factors.

The impact of socioeconomic status on hand injury severity

Socioeconomic status (SES) is an important factor affecting different aspects of human health, including self-care and healthcare service use. The relation between SES and hand injury severity is not well defined; therefore, the present study aimed to investigate the relation between SES and hand injury severity. This cross-sectional descriptive and analytical study included 215 patients with hand injury. Demographic, clinical, and SES-related factors were collected by questionnaire. Injury severity was assessed on Hand Injury Severity Score (HISS). Statistical analysis used the Student t-test, chi-square test and a multinomial regression model to calculate the odds ratio (OR) of each predictive factor. Mean age was 38.02 ± 13.49 years (range, 12-80 years). 73.5% of the participants were men. Patients with low SES were significantly more likely to develop severe hand injury (OR = 5.25 and 9.25 at HISS levels 3 and 4, respectively). In addition, there was a significant association between being born in rural areas and severe (HISS level 3, OR = 2.63) or major (HISS level 4, OR = 2.63) hand injury. Also, major (HISS level 4) hand injuries were significantly more prevalent in patients living in rural areas (OR = 4.23) and those injured in road accidents (OR = 1.98) or practicing sports (OR = 3.51). The study concluded that patients with low SES were 5-10-fold more likely to suffer from severe and major hand injuries, and thus provided valuable information for Iranian policymakers to take preventive measures for hand injuries. It is recommended to improve postoperative care in patients with low SES who underwent hand surgery, take the necessary measures to decrease the incidence of road accident injuries, facilitate early referral of patients with hand injury to trauma centers, and improve postoperative follow-up until full recovery. LEVEL OF EVIDENCE: III.

Assessing and Improving Fitness to Drive in the Elderly People: A Scoping Review of Policies and Guidelines

Background

This study has been conducted to analyze the processes, models, and policies to assess fitness to drive and improving driving in the elderly in the world.

Methods

The Arkesy and O'Malley frameworks were employed. Articles with at least one aspect of driving eligibility in the elderly were included. Expected data were collected using appropriate keywords from PubMed, Web of Science, Scopus, Embase, IranDoc, SID, and MagIran. Data were analyzed using the Content Analysis method.

Results

Out of 675 records, 24 papers and reports were included in the study that all of them were High-Income Countries (HICs). Among the studies that referred to the baseline age, the highest frequency was 70 yr old (4 studies). Vision assessment was the main item to judge driving fitness (mentioned in 75% of the studies). The in-person (5 studies) was the most common method of renewal. General practitioners were the principal performers to measure driving fitness (7 studies). Thirteen studies referred to the road tests as part of the driver's license renewal process. In most all reports and papers, there were policies on empowering the elderly driver, including providing safe driving tips, optional driving skills tests, holding retraining courses, etc. The most frequently supporting policies included introducing alternative transportation.

Conclusion

Most HICs have worthwhile experience in measuring and improving the fitness to drive in the elderly and enforce different laws according to social and political conditions. Utilizing these experiences by considering economic and social differences can be useful and practical for middle and low-income countries.

The economic burden of road traffic injuries until one-year after hospitalization: A survey study

OBJECTIVE

Road Traffic Injuries (RTIs) are one of the most crucial and challenging public health problems in low and middle income countries. Despite continuous efforts to estimate both personal and societal costs of RTIs however, their long-term effects have remained marginal. The current study aimed to explore the economic burden of RTIs until one year after the victim's hospitalization.

METHODS

The study included a total of 1150 RTI victims, who were admitted to two trauma-referral hospitals during 2016. Data on direct medical costs, direct non-medical costs and indirect costs were gathered for each study sample via hospital records and phone surveys. Direct and indirect costs from a social perspective were estimated based on Micro Costing Approach followed by the Human Capital Approach. Also, the explanatory variables affecting the costs of RTIs were identified using the liner regression model.

RESULTS

The average amounts of direct (medical, non-medical), indirect, and total costs of RTI were estimated as 2,908 US$ (1,591 US$, 1,316 US$), 5,790 US$, and 8,701 US$ respectively. Also, several variables were significantly affecting the costs of RTIs including age, marital status, employment status, severity of injury, receiving physiotherapy care, victim's vehicle type in crash, crash time and location.

CONCLUSIONS

Findings suggest that RTIs are considered as an enormous burden on Iranian GDP per capita and health expenditure per capita occupying 167% and 347% respectively. This enormous economic burden caused by RTIs requires more policy regulations and prevention programs to decrease RTIs.

Effect of education on knowledge of fertility counseling and attitudes toward fertility control

BACKGROUND

The development of any society depends on proper planning in various fields such as population and birth control. Fertility control is designed to create a level of population growth appropriate to the resources available and to ensure a good life. Receiving information and education is one of the basic strategies to change the attitude toward fertility and awareness in most people in society. Therefore, this study was conducted to determine the effect of education on knowledge of fertility counseling and attitudes toward fertility control in health workers.

MATERIALS AND METHODS

The present study was a randomized clinical trial with a control group that was conducted in the presence of 107 health workers of health centers and community health centers working in Mashhad in 2017. The research units were randomly divided into three groups (webinar training, group discussion training, and control). Research tools were researcher-made questionnaires on attitudes toward fertility and measuring healthy reproductive awareness that all study participants completed at the beginning of the study and 2 weeks after the intervention. Data analysis was performed by the Chi-square, one-way analysis of variance, and independent t-test using the SPSS software version 16.

RESULTS

The results of this study showed that at the beginning of the study, all three groups were homogeneous in terms of quantitative and qualitative demographic variables including age, education, work experience, type of employment, and number of family members. The results of Kruskal-Wallis test showed that before the intervention, the three groups did not have a statistically significant difference in terms of mean scores of awareness about fertility counseling (P = 0.77) and attitude toward fertility control (P = 0.523), but this relationship was significant after the interventions. Furthermore, the results of Mann-Whitney intragroup test showed that the scores before and after the intervention were significant in both educational groups (P = 0.001).

CONCLUSION

Considering the importance of healthy fertility counseling and the important place of education in promoting awareness and attitude toward healthy fertility, it is recommended to use active educational methods to promote the awareness and attitude of health workers to provide healthy fertility services to couples.

Motorcycle risky behaviours and road accidents among adolescents in Jakarta metropolitan area, Indonesia

INTRODUCTION

Underage motorcycle riding in Indonesia has long been and continues to be common among its citizens. This study aimed to analyse motorcycle risky behaviours associated with motorcycle accidents among adolescents in Jakarta metropolitan area. This is a cross-sectional study employing a self-report survey of 3880 students from 37 junior and senior high schools in the Jakarta metropolitan area, Indonesia, between April and June 2019. About 40% of the respondents reported that they ever involved in motorcycle accidents in the past 12 months. Speeding, using a mobile phone, drowsy driving, and wrong-way riding were significantly associated with motorcycle accidents. Further, red-light running, applying sudden brake, eating, smoking or drinking, listening to music, drunk driving and drowsy driving have an influence on the severity of motorcycle accidents. 91.3% of motorcycle drivers in our samples did not have a driving license, and approximately 39% of them had involved in motorcycle accidents. More stringent controls from parents, schools and the government are needed to inhibit motorcycle use by minors.

Developing and validating a measurement tool to self-report pedestrian safety-related behavior: The Pedestrian Behavior Questionnaire (PBQ)

Objective

Pedestrians are road users vulnerable to traffic injuries and fatalities. This study aimed to develop and validate a pedestrian behavior questionnaire to be used in Iran.

Methods

In this cross-sectional study, the initial questionnaire was designed based on the evaluation of previous studies conducted world-wide or in Iran. The initial pack included 127 items. After the assuring the face validity of the questionnaire, 27 experts' opinions in the field of traffic was obtained for assessing/ improving the content validity. To test the reliability of the questionnaire, the test-retest method and internal consistency assessment were used. To evaluate the structural validity, the Exploratory Factor Analysis (EFA) using the principal component and the Varimax rotation was applied.

Results

After completing the face validity and after summarizing the experts' suggestions, 12 questions were deleted. By calculating the content validity ratio and coefficient, 20 and 17 were removed. Also, the average content validity coefficient regarding relevancy, clarity and overall average were 0.86, 0.88, and 0.87, respectively. The Cronbach's alpha coefficient was 0.84. In the last stage and according to the results of the factor analysis, five factors violations, distraction, positive behaviors (group1), positive behaviors (group2) and Aggressive behaviors) were identified from the 29-items questionnaire, which explained 98% of the total variance.

Conclusion

Considering the necessity of using a verified and validated tool for planning and evaluating effective interventions for pedestrians is inevitable. The tool designed in the study was found to be valid and reliable for use to measure pedestrian's behavior and planning to modify high-risk behaviors and enhance safe pedestrian behaviors.

Narcissistic symptoms among Iranian outer-city bus drivers

BACKGROUND

Although very few studies have investigated the association of narcissistic symptoms and aggressive driving, very little is known about association of narcissism and serious traffic outcomes such as crash and serious violation of traffic laws. The aim of this study was to determine whether there is an association between the narcissistic symptoms of professional bus drivers and high risk driving records or crash.

METHODS

A total of 200 outer-city bus drivers were enrolled in 2018 from Tehran origin of trips. The narcissistic symptoms of drivers were assessed using the Narcissistic Personality Inventory-16 (NPI-16). The traffic police databases were searched for records of crashes or recorded negative traffic scores during a 3-year period prior to time of interviews. Data were analyzed using Stata 14 statistical software package.

RESULTS

Mean age of the participants was 44.4 years with a standard deviation of 9.3 years. Fourteen drivers (7%) had a crash history over the past three years. Mean normalized narcissism score was 22.3 among those without a crash history over the past three years versus 18.8 among those with a crash history without statistical significance. Forty-four drivers (22%) had a negative traffic scoring record due to high risk traffic violations registered in police database over the past three years. Mean normalized narcissism score was 22 among those without negative score record over the past three years versus 22.3 among those with a negative score history. However, the difference was not found to be statistically significant.

CONCLUSIONS

The findings of present study does not support an association between crash risk or being a recorded high risk driver and narcissism levels. However, considering the complex risk profile of road traffic crashes, much larger studies are needed to rule it out.

Developing a National Integrated Road Traffic Injury Registry System: A Conceptual Model for a Multidisciplinary Setting

Introduction

Despite a high burden of traffic injuries, effective integrated or linked injury surveillance systems are rarely available in many low- and middle-income countries (LMICs). The aim of the current study was to define a conceptual model for developing a national integrated traffic injury registry in Iran.

Methods

A mult-method study financially and technically supported by the World Health Organization, Iranian Ministry of Health, Iranian Traffic Police, and the Iranian Legal Medicine Organization was conducted. A theoretical framework, forming the core conceptual components, was developed based on expert reviews. The preliminary conceptual model was developed by a panel of experts and tailored through a national workshop of 50 scientists, authorities and experts from nearly all sectors related to road safety promotion and injury management. It was then sent out to external reviewers in order to assess and improve the content validity of the model.

Results

The conceptual model was developed to have six components. These included 1) aims and core definitions; 2) content and core measurements; 3) data flow; 4) data collection routines; 5) organizational matrix; 6) implementation organization. The Haddon's matrix was adapted to be used as the theoretical framework in defining the content and data flow components of IRTIR. Five subcomponents were defined in the content and core measurements component with each having several subcategories. Each subcomponent/subcategory was finally divided into several item groups to guide defining the final data measurement variables. The data flow component was defined with six data sequence stations. Through the organizational matrix component, five major organizations relevant to road traffic safety were defined as core data production contributors. Some organizations also owned several sub-organizations which contributed in this regard.

Conclusion

It is concluded that the IRTIR conceptual model includes the required six components for developing a national integrated registry for Iran. Its main component called, content and core measurements, leads the researchers in developing final data collection tools in developing the national registry of road traffic injuries in Iran.

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).

Epidemiologic study of traffic crash mortality among motorcycle users in Iran (2011-2017)

PURPOSE

Motorcycle accident is a major cause of road traffic injuries and the motorcyclists are considered as vulnerable road users. The present study aimed to determine the epidemiological characteristics of fatal motorcycle crashes in Iran.

METHODS

In this cross-sectional study, a total of 28,356 motorcycle traffic fatalities registered in the Legal Medicine Organization of Iran were analyzed during the period between March 2011 and March 2017. The examined variables included demographic characteristics, helmet use, crash mechanisms, crash location, position state, type of counterpart vehicle, cause of death and place of death. In the study, road traffic mortalities involving drivers and/or passenger of motorcycles were included. Cases or events registered without these conditions were excluded from the study. To analyse the data, SPSS statistics 25 and GraphPad Prism 8 softwares were used.

RESULTS

Of the 122,682 fatal traffic injury cases, 28,356 (23.1%) were motorcycle users, of whom 95.3% were male and 4.7% were female. Most of the motorcycle fatalities belonged to the age group of 18-24 years (29.1%). Head trauma was the major cause of death (59.0%). Also, the overall proportion of safety helmet use among motorcycle crash victims was estimated at 37.4%. Most of the road traffic crash cases (46.8%) happened out of city and half of people (49.9%) died in hospital. About 77.4% of the victims were motorcycle riders and 21.1% were pillion passengers. The highest rate of mortality belonged to the self-employed (38.4%) and then workers (21.8%) and students (10.2%). In addition, most fatalities occurred in people with low education (77.5%) and the least occurred in university graduates (5.5%). Among 31 provinces of Iran, Fars had the highest (9.3%) occurrence rate and Kohgiluyeh and Buyer-Ahmad had the lowest (0.5%). Most of the crash mechanisms were due to motorcycle-vehicle crashes (80.2%), followed by rollover (9.8%).

CONCLUSION

Comprehensive public education and special rules are needed to reduce the rate of deaths in motorcycle crashes.

Motorcyclist risky riding behaviors and its predictors in an Iranian population

Background:

Motorcyclist’s behavior plays an important role in increasing the mortality rate caused by traffic crash. Identifying the risky behaviors of motorcycle riders is essential to maintain and improve the health of motorcycle riders and other community members. The aim of this study was to determine the riding patterns and risky riding behaviors of motorcycle riders in Bukan as a marginal small-sized Kurdish populated district in North-West of Iran and investigating some predictors of it.

Methods:

In this cross-sectional, 340 motorcycle riders of Bukan were studied. By referring to city health center and preparing the city map, the entire city was divided into 14 clusters based on the areas covered by the health centers. Then, 7 clusters were randomly selected out of these 14 clusters. Motorcycle riding behavior questionnaire (MRBQ) was used to study the risky behaviors of motorcycle riders while riding. Both bivariate and multivariate regression analysis methods were used to study the associations.

Results:

All participants were male. Their mean age was 30.2 (SD=9.1). The most common risky behaviors possessed by at least 23% of motorcycle riders included 1) inappropriate control of motorcycle when turning, 2) taking another person without helmet by motorcycle, 3) riding without helmet, 4) taking more than one person by motorcycle, 5) exceeding the permissible speed outer city, 6) exceeding the permissible speed inside the city and 7) carrying heavy load by motorcycle. Mean normalized MRBQ score was 30.5 (SD=11.2). Based on multivariate analysis, age, lacking a riding license, riding experience and average amount of riding were the independent predictors of risky riding score.

Conclusions:

Among the predictive factors that led to high risk behaviors in the studied motorcyclists were low age, marital status, low driving experience, low education, non-use of safety equipment lack of certification. This can be done by increasing drivers' awareness of laws and regulations and promoting the culture of traffic safety to prevent high-risk behaviors in motorcyclists in order to prevent possible injuries.

Barriers to and Facilitators of Road Traffic Injuries Prevention in Iran; A Qualitative Study

Objective:

To identify the barriers to and facilitators of the prevention of road traffic accidents (RTIs) in Iran.

Methods:

In this qualitative study 42 key stakeholders and experts in the field of traffic injuries in Iran were selected based on purpose and theoretical sampling to reach informational saturation. Their views concerning barriers to and facilitators of the prevention of traffic injuries in Iran were studied using semi-structured interviews. Data were analyzed using Content Analysis method.

Results:

Five themes were identified: structural barriers, organizational barriers and planning, socio-cultural barriers, scientific barriers, and inter-sector barriers and 22 sub-themes were extracted. The lack of lead agency, which was among structural barriers, was selected as the main barrier. The five general facilitators included: sensitization of society and authorities, improving the resources and infrastructure (software and hardware), increasing the attention to safety of vehicles and roads, increasing the information and awareness, and use of expert manpower. The sensitization of society and authorities was selected as the most important facilitator.

Conclusion:

According to the key experts, the barriers of policy changes to prevent the RTIs are more numerous than its facilitators. Therefore, planning and paying more attention to removing these barriers and promoting the facilitators seems necessary to reduce RTIs. Having a lead agency in this regard should be the highest priority.

Social Differences in the Prevalence of Road Traffic Injuries among Pedestrians, and Vehicle and Motorcycle Users in Iran: Results of a National Multiple Indicator Demographic and Health Survey (IrMIDHS, 2010)

Background

Traffic injuries are considered as the most important health issues for different countries in the world, especially developing countries that are experiencing rapid social changes. The purpose of this study was to investigate the prevalence of road traffic injuries (RTIs) and its socioeconomic differences among road users in Iran as it is one of the countries with high rates of accidents in the world. The study population included all people in Iran. The target sample was 3,096 clusters consisting of 2,187 urban and 909 rural households.

Methods

Source of the raw data was the Iran's Multiple Indicator Demographic and Health Survey (IrMIDHS) 2010, which is a multi-stage stratified cluster-random cross-sectional study. The logistic regression has been performed for investigating the socioeconomic determinants which influence the RTIs among pedestrian, vehicle, and motorcycle users.

Results

The prevalence of RTIs is 13.8 (95% CI: 13.1, 14.5) per 1,000 people in the year leading up to the study. The injured groups included pedestrians (14.37%), vehicles (38.36%), motorcyclists (43.37%), and 3.9% of users injured with other vehicles. A total of 78.3% of the injured people underwent outpatient treatment or were hospitalized. The mean age in these three groups was significantly increased (27.9, 32.5, 33.4, respectively), and the proportion of men decreased (89.2, 75.2, and 60.6).

Conclusions

RTIs in Iran are higher than previous estimates due to consideration of non-hospitalized cases. Considering the high contribution of human factors in developing countries, these measures should prioritize vulnerable groups.

Epidemiology of Vehicle Fire Fatalities of Road Traffic Injuries in Kerman Province, Iran: A Cross-Sectional Study

BACKGROUND

Vehicle fires are one of the most important causes of fatalities in road traffic injuries (RTIs), but there are no accurate statistics about vehicle fire fatalities (VFFs) due to RTIs in Iran.

AIM

This study aimed to investigate the Epidemiology of vehicle fire fatalities (VFFs) due to road traffic injuries (RTIs) in Iran.

METHODS

In this cross-sectional study, a researcher-made checklist was used to collect the required data from the files of RTI fatalities in the Kerman Legal Medicine Organization (KLMO), or coroner's office. All reported victims of vehicle fires in the ten years from 2007 to 2017 were included in the study. The data were analysed using SPSS ver. 18, with p = 0.05 considered as the level of significance.

RESULTS

The authors found 124 cases of vehicle fire fatalities in Kerman, with a mean age of 30.45 ± 12.41, of which 50% were in the 25-49 years age group. Most frequently, the victims were Iranian (91.9%), married (66.1%), self-employed (51.6%), and urban dwellers (79.8%), and had died because of burns (91.9%). In 46.8% of cases, the victims were the driver, and in the remaining 53.2%, they were the passenger of the crashed vehicle. Most frequently, vehicle fires occurred on extra-urban roads (90.3%), during spring (35.5 %) or summer (32.3%), due to a vehicle-to-vehicle collision (66.9%), between sedans (69.9%), and at night (63.7%). Most victims died at the scene of the incident (87.9%) and had been transferred to hospital by an ambulance (71%).

CONCLUSION

This study indicated that car fires caused the death of young and middle-aged people. The authors suggest the implementation of preventative measures promoting car safety; establishing speed management; establishing laws governing driving, manufacturing and importation of vehicles; construction of safe roads; identifying accident-prone points; installing road warning signs; establishing more roadside stations; ensuring stricter police monitoring; and improving vehicle safety standards and public awareness about the risks of speeding.

Violent deaths among elderly in Attica, Greece: A 5-year survey (2011-2015)

According to World Health Organization (WHO) estimations, approximately 6 million people lose their lives yearly due to some kind of injury, while one-third of these incidents are due to violent acts. Violent deaths include accidents (road traffic accidents, drownings, falls, heat effects etc), suicides as well as homicides. Elderly people seem to be at greater risk due to their special characteristics as a vulnerable social group. The aim of this study was to investigate violent deaths (accidents, suicides and homicides) among elderly people in Attica, Greece, during the period 2011-2015 by examining manner of death with respect to demographic data (gender and age) and toxicological examination results. A total of 546 violent deaths among people over 65 years old were included in this study. Autopsy findings along with toxicological examination results were collected from the archives of the Department of Forensic Medicine and Toxicology of the National and Kapodistrian University of Athens. The findings of the study showed that most of the victims were male (63.74%). The overwhelming majority of violent deaths (425 cases) were accidents, 92 cases suicides, and the remaining 29 cases homicides. Drowning was the leading cause of all accidental deaths, followed by road traffic accidents. Hangings prevailed among violent suicide methods and asphyxiation presented as a predominant homicide method.

Trauma demography and clinical epidemiology of motorcycle crash-related head injury in a neurosurgery practice in an African developing country

OBJECTIVE

Though motor vehicle crashes (MVCs) were the main cause of head trauma from road traffic injuries (RTIs), motorcycle crashes (MCCs) are now a major cause of RTI-related head injury (HI) in many developing countries.

METHODS

Using a prospective database of HIs from a neurosurgical practice in a sub-Saharan African developing country, a cross-sectional survey was conducted for the trauma demography and clinical epidemiology of this MCC-related HI.

RESULTS

Motorcycle crashes accounted for 57% (473/833) of all RTI-related HIs in this registry. The victims, with a mean age of 33.1 years (SD = 18.3), consisted mainly of males (83.1%), those of low socioeconomic status (>90%), and those aged between 20 and 40 years old (56%). MCCs involved only riders in 114 cases (114/473, 32.1%), of which 69% were motorcycle-motorcycle crashes. The HI was moderate-severe in 50.8%; clinical symptomatology of significant HI included loss of consciousness (92%), anisocoria (35%), Abbreviated Injury Scale head (AIS-head) score > 3 (28%), and CT-Rotterdam score > 3 (30%). Extracranial systemic injury involved the limbs most frequently, with an Injury Severity Score (ISS) >25 in 49%. The fatality rate was 24%. MCC-related HI among pedestrian victims involved more vulnerable age groups (the young and elderly) but have lower mean ISS compared to motorcycle passengers (mean ISS = 23.5 [11.6] vs. 27.4 [13.0]; 95% confidence interval [CI], 1.27-6.49; P = .004). In addition, compared to a contemporary cohort of MVC-related HIs in our registry, MCC victims were older (mean age 34.8 years [18.0] vs. 30.8 [18.4]; P = .002); had higher proportions of certain extracranial trauma like long bone fractures (71 vs. 29%; P = .02); and suffered fewer surgical brain lesions (25.5 vs. 17.2%; P = .004).

CONCLUSIONS

Motorcycle crashes are now a significant threat to the heads, limbs, and lives of vulnerable road users in developing countries.

Unintentional Injuries among the Elderly in Rural Areas and Their Related Behaviors

BACKGROUND

Although the role of unintentional injuries as a cause of death in adults is known, there is limited knowledge about such adults' behaviors. This study aims to investigate the frequency of and factors affecting unintentional injuries among the elderly living in rural areas and their related behaviors.

METHODS

A cross-sectional study was carried out in the rural areas of Hamadan County, Iran, in 2016. The sample consists of randomly selected 445 adults aged 60-75 years. Data collection was conducted through face-to-face interviews, using questionnaires.

RESULTS

One hundred and forty-three participants (34.7%) experienced 166 injury occurrences. The injuries occurred more in females than in males. There were more mild and severe injuries (48.2% and 31.3%, respectively) than moderate ones (20.5%). The most frequent mechanism of injuries was accidental falls (64.5%). There was a significant relationship between using aid devices and injuries (P=0.001). Among the most applied injury preventive measures as reported by the elderly, crossing streets safely and the use of proper lighting at night had the highest percentages (81.5% and 69.7%, respectively). However, the use of protective handles and plastic flooring in bathrooms in order to prevent slipping had the lowest percentages (less than 1.0%).

CONCLUSION

The injuries among the elderly in this study were important health concerns. Injury-related factors should be considered in the development of injury prevention programs.

Prevalence and Socio-Economic Determinants of Disabilities Caused by Road Traffic Accidents in Iran; A National Survey

Objective

To determine the prevalence and socio-economic disparity among victims with disabilities caused by RTAs in Iran as country with a high rate of accidents.

Method

The source of data was the Iranian Multiple Indicator Demographic and Health Survey, a nationwide cross-sectional study. The sampling framework was based on the population and housing census for Iran in 2006. Provincial samples ranged from 400 to 6,400 households. The target sample was 3,096 clusters consisting of 2,187 urban and 909 rural clusters. In the present study, all but a few indicators are reported at provincial levels. Mortality indicators, accident and disability rates, low birth weight rate and young age at marriage rates are presented at the national level only. Logistic regression was performed to investigate the individual and family factors influencing RTAs that lead to disability in Iran.

Results

The period prevalence (12 months) of road traffic accident disabilities (RTADs) in the total population of 111415 was 30.52 (95% CI: 21.13.41.64) per 100,000 individuals. Among those who had been injured during the year leading up to the study, the proportion of disabilities caused by RTAs was 31.67 (95% CI; 8.51.54.97) per 1000 pedestrians, 20.99 (95% CI: 13.37.30.75) per 1000 motorcyclists, 18.64 (95% CI: 7.71.29.57) per 1000 vehicle drivers. Multivariate logistic regression analysis showed that the risk of RTADs differed significantly in relation to age (AOR 50-59 vs. 0-9=10. 78, p-value:0.05); activity status (AOR unemployed vs. employed=4.72, p-value:0.001) and family income (AOR q2 vs. q1=0.37, p-value:0.048) of the victim.

Conclusion

In addition to the risks associated with socio-economic groups, particularly vulnerable groups, RTADs have consequences which can lead to further marginalization of individuals, can affect their quality of life and damage the community as a whole.

Socioeconomic Inequality in Mortality from Road Traffic Accident in Iran

BACKGROUND

Although the epidemiology of road traffic accidents (RTAs) and their determining factors have been extensively investigated and debated in Iran, yet there is no data regarding socioeconomic inequalities in mortality from RTA in Iranian context. Since effective interventions to control, management and diminish the negative influence of RTAs would require understanding of numerous contributing factors, including the inequalities We aimed to quantify for the first time the socioeconomic differential in mortality or injuries from RTAs.

STUDY DESIGN

A cross-sectional study.

METHODS

Overall, 50755 died and injured people from RTA from Mar 2015 to Feb 2016 were evaluated. The data were taken from traffic police department in Iran. We calculated concentration index (CI) to measure socioeconomic inequality in traffic-related mortality & injury. Data were analyzed using Stata software.

RESULTS

The mortality and injury rate from accidents was 1130.80 per 10000 accidents. The concentration index was negative for mortality rate (-0.11) of RTA, indicating the higher concentration of the rates among deprived groups.

CONCLUSION

People with low socioeconomic level were more at risk for fatal accidents and injuries. Therefore, specific interventions on road safety should be delivered in the deprived drivers which uses from low safety level vehicles.

Epidemiology of Road Traffic Injuries among Elderly People; A Systematic Review and Meta-Analysis

Objective:

To systematically review the epidemiological patterns and interventions for prevention of road traffic injuries (RTIs) among elderly.

Methods:

Searching keywords including: accident, trauma, road injury, road traffic injuries, aging, old, elder, strategy, intervention, road traffic crash prevention and traffic accident in databases including, Google scholar, SID, IranMedex, PubMed and Scopus. English and non-Persian articles, articles presented in congresses, articles that considered elderly people to have age under than 60 years were excluded. The reporting quality of articles was assessed by two experts using Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) check list.

Results:

RTIs compromised 23.6% of total injuries among elderly. The most frequent injuries were about car accidents (51.4%). Pedestrian injuries composed 48.1% of the RTIs. Head and neck (32.1%) were most injured body parts. There was a significant difference between elderly and non-elderly people in terms of RTIs associated mortality (Odd=2.57 [1.2-5.4 CI 95%]). Overall 25 main domains of intervention and 73 subordinate domains were extracted in five categories (human, road and environment, tools and cars, medical, legal and political issues).

Conclusion:

According to the notable prevalence and fatality of RTIs, lack of sufficient studies and valid evidence of the present study can provide an appropriate evidence for better interventions for RTIs prevention among elderly.

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.

Population-based epidemiology of non-fatal injuries in Tehran, Iran

Background: Our aim in this survey was to explore descriptive epidemiology of injuries in Tehran in 2012 and to report the recalled estimates of injury incidence rates.

Methods: A population survey was conducted in Tehran during 2012, within which a total of 8626 participants were enrolled. The cluster sampling was used to draw samples in 100 clusters with a pre-specified cluster size of 25 households per cluster. Data were collected on demographic features, accident and injury characteristics based on the International Classification of Diseases (ICD10).

Results: A total of 618 injuries per 3 months were reported, within which 597 cases (96.6%)were unintentional injuries. More than 82% of all injuries were those caused by exposure to inanimate mechanical forces, traffic accidents, falls and burns. Above 80% of the traffic injuries happened among men (P<0.001). About 43% of the unintentional injuries were mild injuries.After the age of 40, women, unlike men, had higher risks for being injured. The estimated annual incidence rate for all types of injuries was 284.8 per 1000 (95% CI: 275.4-294.4) and for unintentional injuries was 275.2 per 1000.

Conclusion: Injuries are major health problems in Tehran with a highly reported incidence. The status is not substantially improved over the recent years which urges the need to be adequately and emergently addressed. As the incidence rate was estimated based on participant recalls, the real incidence rate may even be higher than those reported in the current study.

Epidemiology of Road Traffic Injury Fatalities among Car Users; A Study Based on Forensic Medicine Data in East Azerbaijan of Iran

Objective

To study the epidemiology of car user road traffic fatalities (CURTFs) during eight years, in East Azerbaijan, Iran.

Methods

A total of 3051 CURTFs registered in East Azerbaijan forensic medicine organization database, Iran, during 2006-2014, were analyzed using Stata 13 statistical software package. Descriptive statistics (p<0.05) and inferential statistical methods such as Chi-squared test and multivariate logistic regression with p<0.1 were applied.

Results

Of the 7818 road traffic injury (RTI) deaths, 3051 (39%) were car users of whom 71% were male (mean age of 36.7±18.5 years). The majority of accident mechanisms were vehicle-vehicle crashes (63.95%), followed by rollover (26.24%). Crash causing vehicle fall increased the pre-hospital death likelihood by 2.34 times. The prominent trauma causing death was head trauma (in 62.5%). In assessing the role of type of counterpart vehicle on pre-hospital mortality, considering the other cars to be the reference group for comparison, deceased victims were 1.83 times more likely to die before hospital when the counterpart vehicle was a truck and 1.66 times more for buses.

Conclusion

Decreasing the car users' fatalities using appropriate strategies such as separating the roads for heavy and light vehicles and improving the injury related facilitation may be effective. Male drivers with low education could be prioritized for being trained.

Effectiveness of Interventions for Prevention of Road Traffic Injuries in Iran and Some Methodological Issues: A Systematic Review

Objective

To review the effectiveness of Road Traffic Injuries (RTIs) interventions implemented for prevention of RTIs in Iran and to introduce some methodological issues.

Methods

Required data in this systematic review study were collected through searching the following key words: "Road Traffic Injuries", "Road Traffic accidents", "Road Traffic crashes", "prevention", and Iran in PubMed, Cochrane Library electronic databases, Google Scholar, Scopus, MagIran, SID and IranMedex. Some of the relevant journals and web sites searched manually. Reference lists of the selected articles were also checked. Gray literature search and expert contact was also conducted.

Results

Out of 569 retrieved articles, finally 8 articles included. Among the included studies the effectiveness of 10 interventions were assessed containing: seat belt, enforcements of laws and legislations, educational program, wearing helmet, Antilock Braking System (ABS), motorcyclists' penalty enforcement, pupil liaisons' education, provisional driver licensing, Road bumps and traffic improvement's plans. In 7 studies (9 interventions) reduction of RTIs rate were reported. Decreased rate of mortality from RTIs were reported in three studies. Only one study had mentioned financial issue (Anti-lock Brake System intervention). Inadequate data sources, inappropriate selection of statistical index and not mention about the control of Confounding Variables (CV), the most common methodological issues were.

Conclusion

The results of most interventional studies conducted in Iran supported the effect of the interventions on reduction of RTIs. However due to some methodological or reporting shortcoming the results of these studies should be interpreted cautiously.

Assessment and prediction of road accident injuries trend using time-series models in Kurdistan

Background

Road traffic accidents are commonly encountered incidents that can cause high-intensity injuries to the victims and have direct impacts on the members of the society. Iran has one of the highest incident rates of road traffic accidents. The objective of this study was to model the patterns of road traffic accidents leading to injury in Kurdistan province, Iran.

Methods

A time-series analysis was conducted to characterize and predict the frequency of road traffic accidents that lead to injury in Kurdistan province. The injuries were categorized into three separate groups which were related to the car occupants, motorcyclists and pedestrian road traffic accident injuries. The Box-Jenkins time-series analysis was used to model the injury observations applying autoregressive integrated moving average (ARIMA) and seasonal autoregressive integrated moving average (SARIMA) from March 2009 to February 2015 and to predict the accidents up to 24 months later (February 2017). The analysis was carried out using R-3.4.2 statistical software package.

Results

A total of 5199 pedestrians, 9015 motorcyclists, and 28,906 car occupants' accidents were observed. The mean (SD) number of car occupant, motorcyclist and pedestrian accident injuries observed were 401.01 (SD 32.78), 123.70 (SD 30.18) and 71.19 (SD 17.92) per year, respectively. The best models for the pattern of car occupant, motorcyclist, and pedestrian injuries were the ARIMA (1, 0, 0), SARIMA (1, 0, 2) (1, 0, 0)₁₂, and SARIMA (1, 1, 1) (0, 0, 1)₁₂, respectively. The motorcyclist and pedestrian injuries showed a seasonal pattern and the peak was during summer (August). The minimum frequency for the motorcyclist and pedestrian injuries were observed during the late autumn and early winter (December and January).

Conclusion

Our findings revealed that the observed motorcyclist and pedestrian injuries had a seasonal pattern that was explained by air temperature changes overtime. These findings call the need for close monitoring of the accidents during the high-risk periods in order to control and decrease the rate of the injuries.

A decade of road traffic fatalities among the elderly in north-West Iran

Background

Iran has a uniquely catastrophic status for road traffic injury incidence and fatality. The elderly account for a substantial number of the hospitalizations and fatalities due to traffic injuries. The aim of this study was to investigate the crash mechanisms and medical outcomes of traffic fatalities among the elderly in East Azerbaijan province of Iran during the period 2006–2016.

Methods

A total of 9435 fatalities registered in East Azerbaijan forensic medicine database, Iran, during 2006–2016, were investigated. Of these, 1357 were elderly persons (age > 65). Both victim- and crash-related variables were compared for the elderly and other age groups. Bivariate and multivariate analysis methods were applied using Stata statistical software package version 13.

Results

Of the 9435 fatalities, 1357 victims (14.4%) were elderly persons. The mean age of the elderly traffic fatalities was 75.3(SD = 6.2) years. About 78% of the elderly versus 80% of those in other age groups were males. A decreasing trend of fatal traffic accidents was observed over the study period both for the elderly and other age groups. The elderly were nearly seven times more likely to die as a pedestrian compared to other age groups. By exclusively analyzing pedestrians, it was found that motorcycles were responsible for pedestrian deaths in 9.1% of the fatalities while this figure was 5.5% for pedestrians in other age groups killed in a traffic accident (P < 0.05). About 56% (N = 761) of the elderly died in hospital which was higher than the proportion for other age groups (39%). Ambulance was the main vehicle for transferring the injured victims in four-fifths of the cases both for the elderly and other age groups. Although, in the present study, head injuries were the most common type of injury regardless of the age group, the elderly had a lower percentage of head injuries and a higher percentage of injuries to the torso, pelvis and limbs compared to younger victims.

Conclusions

Pedestrian inner-city crashes in East Azerbaijan province of Iran are a major cause of road injury fatalities among the elderly and should be considered as a priority in road safety interventions.

The Effect of Implementation of the Standard Clinical Practice Guideline (CPG) for Management of Multiple Trauma Patients Admitted to an Emergency Department

INTRODUCTION

The purpose of triage in the standard Clinical Practice Guide (CPG) for multiple trauma patients is to perform the primary and secondary evaluations in the quickest and shortest possible time with minimal errors and the best quality in the emergency department (ED).

OBJECTIVE

In this study, a practical program for a coordinated management of multiple trauma patients in the ED has been provided by using the CPG guide. The impact of its implementation on the multiple trauma patients' management was evaluated.

METHODS

This is a cross-sectional study conducted in 2014 and 2015 in Isfahan's Al-Zahra hospital ED. Administration and management of multiple trauma patients had been prepared before the implementation of the plan based on standard clinical methods of implementation in a way that used a 12-step protocol for the practical guide. This protocol was designed as a flowchart and the results before and after its implementation were evaluated.

RESULTS

In this study, 100 multiple trauma patients before and after the implementation of the protocol were studied. The mean age of the patients and other baseline characteristics of studied patients in the two periods before and after implantation of the CPG were not significantly different (p > 0.05). The frequency of intubation (p = 0.016) and sent to the operating room (p < 0.001) were different in the two study periods. However, hospitalization in the ICU (p = 0.35) and death (p = 0.73) before and after implementation of the protocol were not statistically different. The time before examination by the EM physicians was significantly lower in all triage levels after CPG implementation. Meanwhile, no change in time elapsed occurred for the surgeons except for the patients in level 2 of triage.

CONCLUSION

Implementation of the strategic plan of CPG lead to a significant reduction in waiting time for visits by emergency medicine services and other specialized services, increased the deployment of patients needing surgery, and reducing the time spent in the ED.

Policy Analysis of Road Traffic Injury Prevention in Iran

Introduction

Due to the large number of Road Traffic Injuries (RTIs) in Iran, authorities have implemented a number of policies for the prevention of RTIs. However, a scientific analysis of these policies has thus far been neglected. Therefore, this study was conducted for policy analysis of RTIs prevention in Iran.

Methods

This qualitative study with a case study approach was conducted in Iran during 2016 in two phases: First, by reviewing literature and documents of the past ten years, policies that have been executed to prevent RTIs in Iran were identified. In the second phase of the study, the identified policies were ranked by prioritization matrices. The two policies with the highest scores were selected. ‘Policy triangle framework’ was used for Policy analyzing. Stakeholders of these policies (42 people) were interviewed. Data were analyzed manually by implementing Content-Analysis methods.

Results

The policies of “pupil liaisons” and “safety belt” were selected for analysis from thirteen potential identified polices. The results of some studies revealed that safety belts had not been properly used in Iran (less than 80%). There was an eight-year hiatus between the approval of the safety belts policy and implementation of this policy. Eight actors were identified for safety belts policy. Lack of diligence in implementation of the policy, failing to pay adequate attention to education and the culture of driving, and failing to select an organization for the implementation of the policy, were identified as the main weaknesses of this policy. For ‘pupil liaisons’ policy, five actors were identified. Following the implementation of this policy, the number of penalties was reduced (17.9%). Neglecting scientific findings and individual-based nature of the policy were identified as the primary weaknesses of this policy.

Conclusions

Taking serious measures to properly execute the policy, educating people, selecting an efficient organization that is responsible for the implementation of the policies, and using international experience are the measures that can be taken to reduce the number of RTIs in the country.

Determinants and barriers of helmet use in Iranian motorcyclists: a systematic review

Background:

Helmet use by motorcyclists decreases the incidence and severity of an injury and its related death. Unfortunately, the helmet use rate is not in an acceptable level in Iran. This study aimed to systematically identify the determinants and barriers of helmet use among Iranian motorcyclists.

Methods:

A systematic search of literature was done using PubMed, Scopus, Science Direct and Web of knowledge databases for English literature and SID for Persian articles by specified keywords. Manual searching and reference of references were used to improve the articles identification. Articles published before 1995 and those which did not report the barriers and determinants of helmet use were excluded. Data were extracted using an extraction table.

Results:

Out of 49 retrieved articles, 13 articles were included in the study. Most of them (70%) had a cross-sectional design. Personal factors (such as older age, marital status and education) and motorcyclist's attitude and beliefs about the helmet effectiveness were reported as important determinants of helmet use. Helmet weight and its visual and audial limitation for motorcyclists were known as the main reported barriers to use a helmet.

Conclusions:

Interventions affecting the motorcyclists' attitude must be employed along with the legal interventions. Moreover, cost-effective engineering improvements in helmet production remain an important policy to improve the compliance of helmet use.

Injury epidemiology in Iran: a systematic review

Background:

Injuries are the second greatest cause of mortality in Iran. Information about the epidemiological pattern of injuries is effective in decision-making. In this regard, the aim of the current study is to elaborate on the epidemiology of injuries in Iran through a systematic review.

Methods:

Required data were collected searching the following key words and their Persian equivalents; trauma, injury, accident, epidemiology, prevalence, pattern, etiology, risk factors and Iran. The following databases were searched: Google Scholar, PubMed, Scopus, MagIran, Iranian scientific information database (SID) and Iran Medex. Some of the relevant journals and web sites were searched manually. The lists of references from the selected articles were also investigated. We have also searched the gray literature and consulted some experts.

Results:

Out of 2747 retrieved articles, 25 articles were finally included in the review. A total of 3234481 cases have been investigated. Mean (SD) age among these cases was 30 (17.4) years. The males comprised 75.7% of all the patients. Only 31.1% of patients were transferred to hospital by ambulance. The most common mechanism of injuries was road traffic accidents (50.1%) followed by falls (22.3%). In road traffic accidents, motorcyclists have accounted for the majority of victims (45%). Roads were the most common accident scene for the injuries (57.5%). The most common injuries were to the head and neck. (47.3%). The mean (SD) Injury Severity Score (ISS) was 8.1(8.6%). The overall case-fatality proportion was 3.8% and 75% of all the mortalities related to road traffic accidents.

Conclusions:

The main priorities in reducing the burden of injuries include: the young, male target group, improving pre-hospital and ambulance services, preventing road traffic accidents, improving road safety and the safety of motorcyclists (compulsory helmet use, safer vehicles, dedicated motorcycle lanes).