Road accidents on Indian National highways, ambulance reachability and transportation of injured to trauma facility: Survey-based introspection of golden hour

Background

The transportation system plays a crucial role in the context of socioeconomic development, whereas the highway infrastructure acts as a base for the transportation system. In recent years, a rich impetus has been given to the development of road infrastructure by Indian governance. There is a need to introspect how well the prevailing highway infrastructure is equipped with emergency rescue management during road accidents. Lack of ambulance service and trauma facilities along the highways results in a steady loss of lives and injuries and increases people's exposure to risks.

Objective

This study aims to determine the response time of ambulance reachability to the accident spot on Indian national highways associated with heavy commercial transportation. Also, determining the time to transport the injured to the nearest trauma facility is another factor included as an objective in this investigation.

Methods

The study adopted survey-based research, whereby the variables in the questionnaire were designed to record and assess the time for an ambulance to reach the accident spot and, from there, to transport the injured to the trauma management facility on Indian highways. Two hundred twenty-five participants who were either victims/relatives of victims or those involved in the rescue of the injured have participated in the survey. The dates of the accident events were 2017 and 2022.

Results

The survey resulted in the identification of two categories of highway accidents. The first category of accidents happened on the highways near city limits/dense settlements, and the second category occurred on the core highways. The percentage of accidents caused on the highways either adjacent to or passing through the city limits/dense settlements was reported to be higher than the accidents on the core highways. Ninety percent of the participants reported successful contact with the ambulance call/service centre, but only ~75% success rate exists for ambulances to reach the accident scene. On the core highways, the time taken for the ambulance to arrive at the accident scene is 25-35 minutes. The results from the survey ascertained that the patients were prioritised for treatment in the nearest hospitals (irrespective of having a trauma facility) at a distance of ~12-20 km, for which the time taken is ~15-25 minutes. Importantly, from the interviews, it is understood that in many cases, these hospitals have further referred to specialty hospitals located in nearby cities or trauma centres with greater facilities. Occasions exist where the injured were taken directly to hospitals 30-40 km from the accident spot, for which the time was more than 40 minutes.

Conclusions

The results provide evidence that in either of the accident cases on the highways that are adjacent to/passing through the city limits or on the core highways, the total time for emergency care accessibility is nearly 60 minutes or greater; this implies that in the majority of cases, there is very meagre time left to provide emergency medical care to the needy and injured on the Indian highways to abide by the concept of golden hour. Plausible reforms backed by technology for enabling highways into 'emergency rescuable highways' are highly needed to guarantee a safer and more sustainable transportation system in India.

Spike of Motorbike Accidents in Bangladesh: An Emerging Public Health Concern

The on-road traffic accident is a significant public health concern for Bangladesh, impeding the country's way to building safe, resilient, and sustainable cities and human settlements. On-road accidents and causalities doubled in the country between 2011 and 2020, and it increased by 30% in 2021, a shifting pattern of traffic accidents with an increasing number of motorbike accidents. The fatalities by motorcycle traffic accidents were only 4% in 1995 and rose substantially to 35% in 2021, and the situation has been more alarming during the festivals, especially Eid in Bangladesh.

Prevalence and Determinants of Road Traffic Accidents in Saudi Arabia: A Systematic Review

Globally, the frequency of road traffic accidents (RTAs) is sharply rising. It is concerning that the number of RTAs in the Kingdom of Saudi Arabia (KSA) has risen within the past ten years. As a result, laws governing things like speeding and seat belt use must be implemented to ensure driving safety. This study aims to determine the prevalence and determinants of road traffic accidents in Saudi Arabia. A thorough search was carried out in November 2023, mostly using PubMed, in compliance with PRISMA criteria. The search was limited to English-language research examining the causes of road traffic accidents and their prevalence. Certain inclusion and exclusion criteria were developed to guarantee the quality and applicability of the evaluated research. A wide spectrum of research from Saudi Arabia was included in the study without focusing on a specific gender. A discernible pattern indicated a high proportion of individuals affected by road traffic accidents. According to the findings of our investigation, there is growing evidence that Despite recent improvements in the incidence of road accidents, there is still significant variation in the incidence of accidents in Saudi Arabia. These results indicate that further study is needed to understand road accident prevention better.

Distracted Driving Behavior Among Adults in the Perambalur District: A Cross-Sectional Study

Background Distracted driving is a major public health concern. Distraction results in reduced speed control, lateral lane position, reduced situational awareness, and impaired response times to roadway hazards. Visual, cognitive, and manual distractions impair drivers in different ways. With the above background, this study was conducted with the objective of estimating the proportion of distracted driving behavior and its predictors among the adult population in the Perambalur district, Tamil Nadu, India, by using the Total Distracted Driving Scale. Materials and methods A cross-sectional study was conducted among 403 adults aged 18 years and above by convenience sampling technique in the Perambalur district for six months. A pretested, semi-structured proforma was used to collect data on socio-demographic characteristics such as age, sex, education, and occupation. To quantify distracted driving behavior, the Total Distracted Driving Scale was used. This scale contains seven questions about talking on the phone, five questions about texting, and five questions about using specific devices while driving. Data were entered into Microsoft Excel and analyzed using the Statistical Package for the Social Sciences (SPSS) Version 21. Descriptive statistics were used to describe the distracted driving behavior with respect to each variable, and to find out the significance, a corresponding statistical test was employed. A p-value of less than 0.05 was considered statistically significant. Results The mean age of the study participants was 24.86 ± 10.63 years. More than half of the study subjects (52.4 percent) were females, and around 87.3 percent of them were Hindu by religion. Among the study participants, around 66.74 percent mentioned that they had used a cell phone while driving. Around 38 percent of the study participants admitted that they had been in or were near-crash circumstances during the past year. Around 87 percent of the study participants who had a crash or near-crash in the past year admitted that they had been distracted while driving. On primary analysis, religion of individuals and increased driving frequency had a statistically significant association with a history of distracted driving. Study participants who were using three- and four-wheelers and those who used cellphones while driving had a statistically significant association with a history of distracted driving. According to the regression, cell phone users are 3.915 times more distracted than those who do not use cellphones (p = 0.001). Subjects with a history of crashes or near-crashes were 56.96 times more distracted than those without a history (p < 0.001). Conclusion In the present study, three-fourths of the study population used a cell phone while driving. More than three-fourths of the study participants admitted that they had been in a crash or near-crash circumstances during the past year. Distracted driving was responsible for four-fifths of all crashes or near-collisions. Use of a cell phone while driving and a history of near-crashes have a higher risk of distraction than those who do not.

Characteristics of E-Scooter-Related Maxillofacial Injuries over 2019-2022-Retrospective Study from Poznan, Poland

Recently, there has been a considerable rise in the popularity and use of electric scooters. Because of this, the number of accidents involving them has also risen. Head and neck injuries are the most common. The aim of the study was to determine the most frequent craniofacial injuries resulting from accidents involving electric scooters, and to identify the risk factors directly related to their placement and severity. The study carried out a retrospective analysis of the medical records of patients of the Clinic of Maxillofacial Surgery over 2019-2022, in terms of craniofacial injuries suffered as a result of e-scooter-related accidents. In the study population (31 cases), of which 61.3% were men, the median age was 27 years. At the time of the accident, 32.3% patients were under the influence of alcohol. Accidents were most common in the 21-30 age group; more often than not, they occurred during warm months and on weekends. The study identified a total of 40 fractures in the patients. The most common craniofacial injuries were mandibular fractures (37.5%), zygomatic-orbital fractures (20%) and frontal bone fractures (10%). A multidimensional correspondence analysis was also performed, which showed that at an age of under 30, alcohol consumption and female gender were associated with a higher likelihood of mandibular fracture. Proper education on the risks associated with the use of e-scooters is essential, with particular emphasis on the impact of alcohol on the driver. It is important to develop diagnostic and therapeutic algorithms for doctors, both in ED and in specialised departments.

Perceived Importance of Public Health Risks in Greece: A Nationwide Survey of the Adult Population

The current study is the first to examine the perceptions of the Greek public towards selected health risks and prioritize perceived risk importance and the needs to be addressed for public health promotion. Participants were asked to consider the individual importance of selected risks and the top three most important risks. Data collection took place on February 2020 in a representative sample of the adult Greek population. Differences between groups were assessed with Chi-square tests. Logistic regression models were used to identify perceptions based on participants’ characteristics. Analysis was conducted in Stata 14, and 1976 adults participated in the survey: 48% male and 52% female. Road accidents, cancer and air pollution and environmental protection were considered the top three most important public health risks. Differences were observed between sexes; females were more concerned regarding the importance of the examined public health risks, and between age groups, younger ages considered STDs and contraception more important than older ages. Finally, non-smokers considered exercise and smoking to be more important than smokers. This is the first study to present and grade the public’s perceptions on the importance of public health risks in Greece. Our study’s prioritization of health risks could aid health authorities in improving and promoting the overall public health in Greece.

Barriers to using a helmet among motorcyclist students: a qualitative study

BACKGROUND

Helmet use rates among motorcyclists are low and various factors are involved. Therefore, the present study aimed to investigate the factors affecting the use of helmet in motorcycle students in Iran (Bandar Abbas city) in 2019.

METHODS

The research was qualitative and data were collected through individual interviews and observations and were interpreted by content analysis method. Participants were 15 motorcyclist students studying in public health (6), nursing (4), dentistry (2), medicine (1), health education (1) and biochemistry (1). They were purposefully included in the study and sampling continued until data saturation. The main tool for data collection was deep semi-structured interviews with open answers which lasted for 20 to 60 minutes. Finally, 15 interviews were collected in this study.

RESULTS

The five main categories (economic, family, socio-cultural, individual, and riding rules) were extracted from the data that each had a subclass.

CONCLUSIONS

Different factors in micro and macro dimensions play a role in the use of helmets among motorcyclists. Consideration of these factors by the relevant organizations in the field of traffic can increase the use of helmets.

Driving Behavior That Limits Concentration: A Nationwide Survey in Greece

Human behavior is implicated in most road accidents. The current study examined drivers’ behavior that interferes with decision making and reaction time to an incidence. Adults (≥17 years-old) participated in a questionnaire-based survey for driver’s behavior. Dataset was weighed according to sex, age and education based on the 2011 census. Differences between groups were assessed with Chi-squared tests while logistic regression models were used to identify drivers’ characteristics for specific behaviors. A total 1601 adults participated in the survey—48% males and 52% females. Texting, Global Positioning System (GPS) setting and smoking were observed more by professional drivers and drivers of an urban area, while smoking was also dependent on social class. Drink driving was observed more by males (20% vs. 5% females), while after adjusting for age, the odds of drink driving in males were 5 times higher than females (p < 0.001). A different effect of age depending on the driver’s sex and vice versa was observed regarding phone calls. Drivers’ behavior with distractive potential differed by age, sex, social class and area of residence. Male drivers were more likely to perform drink driving, while professional drivers were more likely to use cell phone for calls and texting, set the GPS and smoke while driving.

Crash model based on integrated design consistency with low traffic volumes (due to health disaster (COVID-19)/movement control order)

Malaysia is listed as one of Asia's developing countries with high-road accidents rate. The accident involves the most between the motorcyclist and other vehicles such as a passenger car which is 17 times safer than the motorcyclist. Current research reveals that the three major forms of incidents in Malaysia are single-motorcycle incidents, passenger car crashes and cars–motorcycles crash. In general, the lack of accuracy of road geometric design, traffic volumes and overlapping movements of vehicles was the main cause of road accidents in Malaysia, which caused drivers to make mistakes and errors due to road geometric characteristics and traffic environments. However, during our recent COVID-19 pandemic, the traffic volumes are relatively low in the whole country as the government announces the movement control order in March 2020. The country was almost completely lockdown (people and vehicles' movements were controlled). In contrast with the reduction of the traffic volumes, the number of crashes shows relatively high numbers. This phenomenon can be derived so that other factors cause vehicle crashes and fatalities should be considered. Several factors related to road geometric such as lane width, shoulder width, access point, curve length and tangent length are considered in developing profiles of operating speed for motorcycles and cars formed of tangents and curves. The analysis of the geometric factors and traffic environments took place at federal road F0050 from 21 to 25 km in Johor, Malaysia. This study was carried out using GPS (DG-200) where the data (vehicles tracked movements) on the continuous speed profiles used a current method of analysis to determine the profiles of road design consistency for motorcycles and cars. The profiles are used to measure the importance index of the integrated design consistency model of the road. The model depends on parameters such as the confine region of speed profiles, average speed, and velocity deviation standard of the profiles. Therefore, a special software of ACAD was used to build the profile of the consistency model. The design accuracy of the speed profile in traffic and safety assessments are affected by the integrated-consistency model. The highest number of accidents has been identified at 24 km at F0050 based on the area design consistency where poor design is the integrated quality consistency model for car and motorcycle. The study shows that crashes and fatalities are not fully affected by traffic volumes but road design performances and driving behaviors.

Shame, guilt, time perspective, time of imprisonment and PTSD symptoms in sentenced motor vehicle accidents perpetrators - a preliminary report

OBJECTIVES

The study aimed at exploration of a relationship between PTSD symptoms, traumarelated guilt (TRG), time perspective (TP), and guilt/shame proneness among perpetrators of motor vehicle accidents (MVA). We also analyzed relationships between length of imprisonment, PTSD and trauma-related guilt.

METHODS

The sample consisted of 37 incarcerated perpetrators of MVA. They were asked to fill in the set of questionnaires: Zimbardo Time Perspective Inventory, Guilt and Shame Proneness Inventory, Trauma-Related Guilt Inventory).

RESULTS

The results showed that 50% of the perpetrators met the DSM-5 PTSD criteria. The proneness to guilt and shame positively correlated with the trauma-related guilt. Shame susceptibility as a consequence of negative self-esteem was associated with a greater traumarelated shame. There was no correlation between guilt/shame or trauma-related guilt and PTSD. The time perspective was associated with PTSD - the stronger the tendency of the respondents to focus on the present/past, the greater the symptoms of PTSD. Focusing on the hedonistic present positively correlated with guilt related to trauma.

CONCLUSIONS

In the studied population, every second perpetrator of the accident was affected by PTSD, which was associated with the past and present time perspective. Negative assessment of self and behavior intensified the guilt associated with trauma and reduced the search for justification for one's own actions in external circumstances. Time spent in prison had no effect on moral attitudes or on the moral evaluation of one's own behavior that caused harm to others. However, it was associated with experiencing stress and focusing on one's own suffering.

Maxillofacial trauma following road accidents-An 11-year multi-center study in Israel

BACKGROUND/AIM

Road traffic collisions (RTC) are known to be one of the major causes of maxillofacial trauma (MFT). The road user factor is of crucial importance in the prevalence, severity, and treatment of maxillofacial injuries. The aims of the study were to determine the prevalence of maxillofacial trauma among road users, to illustrate injury patterns and to identify road users at high risk.

METHODS

This historical prospective multi-center study was based on Israel's Trauma Registry between 2008-2018, which included 4829 hospitalized patients following RTC with MFT. Data were analyzed according to six road user types (vehicle driver, passenger, bicyclist, motorcyclist, pedestrian, and e-bike/scooter), maxillofacial injury location, and maxillofacial treatment.

RESULTS

MFT, which accounted for 5% of the hospitalized RTC injuries, was not equally distributed among road users, as bicyclists and e-bike/scooters were more prone to maxillofacial trauma (7.2% and 10.1%, respectively) than vehicle drivers (3.2%). Children (age 0-14 years) comprised almost half of the cyclists, 25% of the pedestrians and 20% of the passengers. Some MFT patients experienced multiple injuries, with the majority involving jaw and facial bones and to a lesser extent the mouth, teeth, gingivae, and alveolar bone (mouth and dento-alveolar (DA) trauma). Approximately 30% of hospitalized road casualties with MFT underwent MF surgery, with the need for surgery lowest among pedestrians.

CONCLUSION

Hospitalized road casualties had different types of MFT in terms of prevalence, location, severity, and treatment, depending on the road user type.

Accident risk analysis based on motorway exposure: an application of benchmarking technique for human safety

Accident risk analysis for human safety and infrastructural improvement are key requirements of the engineering sector. The purpose of this paper is to identify and prioritize problematic segments of roads based upon the risk evaluation concept and to focus on the severity of accidents regarding human life loss and easy manoeuvring. This study includes the concept of considering road segments as decision-making units for application of data envelopment analysis (DEA) technique which has no compulsion of the distribution function and critical assumptions, unlike the multiple regression models. According to the proposed methodology, a section of Motorway (M-2) Lahore-Islamabad has been analyzed. Out of 200 segments under consideration, 99 segments were selected with at least one accident and one injury or fatality. Furthermore, for risk calculation and ranking of road segments, the DEA technique along with the cross-risk matrix method was applied. This optimization technique could not only be helpful in ranking but also technical decision-making and prioritizations for safety improvement, policymaking and budget allocation.

Uncovering the behaviour of road accidents in urban areas

Different patterns in the incidence of road accidents are revealed when considering areas with increased levels of urbanization. To understand these patterns, road accident data from England and Wales is explored. In particular, the data are used to (i) generate time series for comparison of the incidence of road accidents in urban as opposed to rural areas, (ii) analyse the relationship between the number of road accidents and the population size of a set of urban areas, and (iii) model the likelihood of suffering an accident in an urban area and its dependence with population size. It is observed that minor and serious accidents are more frequent in urban areas, whereas fatal accidents are more likely in rural areas. It is also shown that, generally, the number of accidents in an urban area depends on population size superlinearly, with this superlinear behaviour becoming stronger for lower degrees of severity. Finally, given an accident in an urban area, the probability that the accident is fatal or serious decreases with population size and the probability that it is minor, increases sublinearly. These findings promote the question as to why such behaviours exist, the answer to which will lead to more sustainable urban policies.

Determinants of child safety seat use among parents in an International Safe Community, Tehran, Iran

Objective: Road traffic accidents are a global issue and serious threat for public health. Children are at high risk of serious injury or death from motor vehicle crashes. Child safety seats (CSSs) can reduce the risk of death and serious injury in children. This study was done to determine the prevalence of child safety seat use in vehicles and the factors influencing their use in a safe society (Tehran, Iran) in 2015.Methods: In this cross-sectional study, 804 parents with children under 12 years old who owned private cars were questioned in different areas of Tehran. A questionnaire included demographic data, and 2 specific questionnaires were used for families that used a CSS and those did not use a CSS. Univariate and multivariate binary logistic regression analyses were conducted. Crude and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated. All analyses were carried out using SPSS 21.Results: The prevalence of child safety seat use was 18.7% and was significantly higher among parents with an income greater than 50 million rials/month, parents who received child safety seat recommendations, parents living in the north of Tehran, and fathers with more driving experience. Age, weight, and height of children were also factors that influenced the use of child safety seats. The most common reasons for parents to use child safety seats was awareness about the benefits of this device and fear of harm to the child, and the most common reasons for nonuse were child intolerance while sitting in the seat and cost.Conclusion: The prevalence of child safety seat use in Tehran is very low, and most parents are not aware of the importance of child safety seats. Comprehensive programs, including legislation, law enforcement, public education, and publicity to promote the benefits of using CSSs, in Tehran can be an effective step toward increasing the use of child safety devices.

Spatial analysis of mortality rate of pedestrian accidents in Iran during 2012-2013

Objectives: Considering the high mortality rate of pedestrians in traffic accidents in Iran, the present study aimed to determine the high-risk and low-risk areas of accidents resulting in pedestrian deaths and the spatial analysis of their mortality rates. Methods: This cross-sectional study included 4,371 deceased pedestrians reported by the Legal Medicine Organization in Iran from March 2012 to March 2013. For spatial analysis, the collected data were entered into ArcGIS software version 10.2 and a spatial map of the mortality rate was drawn according to the distribution of data in the provinces. Using this software, high-risk and low-risk areas were identified by calculating the spatial autocorrelation of the data. The Moran's index of road accident patterns was surveyed and high-risk and low-risk points were identified using the local Getis index. Results: The age-standardized incidence rate was 6.8 per 100,000. After analyzing the data using ArcGIS software, the local Moran's index showed a cluster pattern with a high mortality rate in 3 provinces of Mazandaran, Gilan, and Qazvin. In identifying high-risk and low-risk points, the local Getis index showed 3 hot spots with a confidence interval of 99% in Qom, Qazvin, and Mazandaran and 5 hot spots with a 95% confidence interval in Markazi, Tehran, Zanjan, Gilan, and Golestan provinces. Conclusions: According to the cluster pattern of accidents in the 3 provinces and the presence of hot spots in 9 provinces, it is necessary to identify factors that increase the risk of death in the study provinces in order to reduce the mortality rate among pedestrians due to traffic accidents. Therefore, to reduce the pedestrian mortality rate, especially in high-risk provinces, some studies need to be conducted to determine the risk factors in pedestrian mortality.

A Review of Driving Restrictions in Patients at Risk of Syncope and Cardiac Arrhythmias Associated with Sudden Incapacity: Differing Global Approaches to Regulation and Risk

The ability to drive is a highly valued freedom in the developed world. Sudden incapacitation while driving can result in injury or death for the driver and passengers or bystanders. Cardiovascular conditions are a primary cause for sudden incapacitation and regulations have long existed to restrict driving for patients with cardiac conditions at high risk of sudden incapacitation. Significant variation occurs between these rules in different countries and legislatures. Quantification of the potential risk of harm associated with various categories of drivers has attempted to make these regulations more objective. The assumptions on which these calculations are based are now old and less likely to reflect the reality of modern driving. Ultimately, a more individual assessment of risk with a combined assessment of the medical condition and the patient's driving behaviour may be appropriate. The development of driverless technologies may also have an impact on decision making in this field.

Driving Behaviors 2-3 Years After Traumatic Brain Injury Rehabilitation: A Multicenter Case-Control Study

Introduction: Driving an automobile is an important activity for the social participation of individuals with traumatic brain injury (TBI). Return to safe driving is usually addressed during rehabilitation, but we know little about driving behaviors in the years following TBI rehabilitation.

Objective: To explore self-reported and objective (official driving records) post-rehabilitation driving behaviors and offenses in individuals with TBI: (a) having passed a driving evaluation, (b) who did not undergo a driving evaluation, and (c) non-injured controls.

Methods: Cross-sectional design with 162 adults: (a) 48 participants with mild, moderate, or severe TBI whose drivers' license was suspended and reinstated following a driving evaluation during rehabilitation (TBI-DE; M = 42.2 years of age, SD = 11.5); (b) 24 participants with TBI who maintained their driving privileges without undergoing a driving evaluation (TBI-NE; M = 36.5 years of age, SD = 9.9); (c) 90 non-injured controls (M = 43.8 years of age, SD = 11.4). Participants with TBI were recruited from seven rehabilitation centers, 2–3 years after the end of rehabilitation in the province of Quebec, Canada. During a telephone interview, data were obtained regarding self-reported driving: (a) habits; (b) self-efficacy; (c) anger expression; (d) sensation-seeking; (e) violations/errors; (f) accidents, driving offenses, and demerit points for the two-year interval predating the study. Objective data for driving offenses, accidents, and demerit points were obtained from the automobile regulatory body for the same period and for the two-year interval before the injury for the TBI groups.

Results: Compared to non-injured controls, the TBI-DE group reported significantly lower scores for self-reported verbal aggressive expression of anger and driving violations/errors. Conversely, their official driving records showed significantly more demerit points for the last 2 years, and a significantly higher frequency of serious post-rehabilitation accidents (10), compared to the TBI-NE group (one) and the control group (none). Compared to pre-injury levels, individuals with TBI had significantly more demerit points post-rehabilitation.

Conclusions: Individuals with TBI may underestimate risky driving behaviors even if they have been deemed fit to drive. Reduced self-awareness, memory, and dysexecutive problems following TBI could influence self-report of driving behaviors and explain discrepancies between self-reported and objective driving-related behaviors. Recommendations for research and practice are provided.

Diagnosis on Transport Risk Based on a Combined Assessment of Road Accidents and Watershed Vulnerability to Spills of Hazardous Substances

Roads play an important role in the economic development of cities and regions, but the transport of cargo along highways may represent a serious environmental problem because a large portion of transported goods is composed of dangerous products. In this context, the development and validation of risk management tools becomes extremely important to support the decision-making of people and agencies responsible for the management of road enterprises. In the present study, a method for determination of environmental vulnerability to road spills of hazardous substances is coupled with accident occurrence data in a highway, with the purpose to achieve a diagnosis on soil and water contamination risk and propose prevention measures and emergency alerts. The data on accident occurrences involving hazardous and potentially harmful products refer to the highway BR 050, namely the segment between the Brazilian municipalities of Uberaba and Uberlândia. The results show that many accidents occurred where vulnerability is high, especially in the southern sector of the segment, justifying the implementation of prevention and alert systems. The coupling of vulnerability and road accident data in a geographic information system proved efficient in the preparation of quick risk management maps, which are essential for alert systems and immediate environmental protection. Overall, the present study contributes with an example on how the management of risk can be conducted in practice when the transport of dangerous substances along roads is the focus problem.

Tetanus associated with road accidents in the infectious diseases department of Point G University Hospital, Bamako, Mali

The aim of this study was to describe the epidemiological, clinical, and prognostic aspects of tetanus associated with road accidents and to make recommendations. This observational study collected retrospective clinical data over a 9-year period about adults admitted for trismus and/or generalized or localized paroxysm after a road accident. The study included 25 patients, accounting for 22.12 % of all tetanus cases. Men were massively overrepresented (sex-ratio M/F: 24/1). The median age was 34 ± 8 years. In all, vaccination status was unknown for 4 patients and known to be negative for 21. Immunoprophylaxis was nonexistent in all cases. The generalized clinical form was dominant (96 %). Severity reached level III for 12 % of patients. The points of entry included open leg fractures (4 cases), head wounds (2), mucocutaneous wounds (14), and muscle contusions (5). The mean time to referral for tetanus was 8 ± 7 days, and the median hospital stay 9.08 ± 11 days. Patients were mostly residents of urban (56 %) and suburban areas (28 %) [P = 0.04]. Two cases were complicated by severe malaria. The mortality rate was 60 %, and 52 % of the deaths occurred within the first 72 hours after hospitalization. It is essential to promote serum therapy and tetanus immunization for patients after road accidents. Increasing the awareness of traditional healers of these treatments deserves consideration.

Usefulness of post mortem computed tomography versus conventional forensic autopsy of road accident victims (drivers and passengers)

Aim of the study: Deaths of in-vehicle victims (drivers and passengers) of road accidents represent a significant group of issues addressed by forensic medicine. Expressing opinions in this regard involves first of all the determination of the cause of death and the forensic pathologist's participation in the process of road accident reconstruction through defining the mechanism of bodily harm. The scope of the opinion as well as its accuracy and degree of detail largely depend on the scope of forensic autopsy. In this context, techniques that broaden the capabilities of standard autopsy are of particular importance. This paper compares the results of post mortem computed tomography (PMCT) of road accident victims (drivers and passengers) against the results of standard examination in order to determine the scope to which PMCT significantly enhances autopsy capabilities. Material and methods: The analysis covers 118 in-vehicle victims (drivers and passengers) examined from 2012 to 2014. In each case, post-mortem examination was preceded by PMCT examination using Somatom Emotion 16 (Siemens AG, Germany). Results: The results are presented in a tabular form. Conclusions: In most road accident victims (drivers and passengers), post mortem computed tomography significantly increases the results' degree of detail, particularly with regard to injuries of bones and gas collections.

Sleep habits and road traffic accident risk for Iranian occupational drivers

OBJECTIVES

The aim of this study is to assess the sleep quality and sleep disorders (prevalence of obstructive sleep apnea and sleepiness) among occupational drivers in Iran and to determine which demographic factors and occupational habits are linked to road traffic accidents.

MATERIAL AND METHODS

In this analytic cross-sectional study 556 occupational road drivers from Shahroud city (in the northeast of Iran) participated, upon a prior verbal informed consent, during 2013-2014. The Pittsburgh Sleep Quality Index (PSQI) standard questionnaire that scored on 7 point scale, the 8-item Epworth Sleepiness Scale (ESS) questionnaire and the 8-question STOP-Bang questionnaire along with demographic information and occupational data were used. To explore the independent factors associated with odds of poor sleep quality and road accident, multiple logistic regression models were used.

RESULTS

Prevalence of previous road accidents, sleepiness while driving, and obstructive sleep apnea scored ≥ 3 in the study, and drivers accounted for 23.8%, 29%, and 24.8%, respectively. The global mean score of sleep quality and excessive sleepiness score were 5.2 and 4.8, respectively. The main factors related to the odds of poor sleep quality were snoring (odds ratio (OR) = 2.34; 95% confidence interval (CI): 1.15-4.77), smoking (OR = 2.12; 95% CI: 1.15-3.97), and driving times in a day (OR = 1.12; 95% CI: 1.03-1.21). The Epworth Sleepiness Scale (OR = 1.13; 95% CI: 1.07-1.23) and suffering from apnea (OR = 4.89; 95% CI: 1.07-23.83) were the best predictors for odds (increased risk) of road accidents.

CONCLUSIONS

A considerable proportion of Iranian drivers had records of road accidents; poor sleep quality, sleepiness while driving, and sleep disorder breathing (obstructive sleep apnea - OSA). Snoring, smoking, driving time in a day, excessive sleepiness, and presumably apnea increase the odds of poor sleep quality and road traffic accident for Iranian occupational drivers.

Application of eye-tracking in the testing of drivers: A review of research

Recording and analyzing eye movements provide important elements for understanding the nature of the task of driving a vehicle. This article reviews the literature on eye movement strategies employed by drivers of vehicles (vehicle control, evaluation of the situation by analyzing essential visual elements, navigation). Special focus was placed on the phenomenon of conspicuity, the probability of perceiving an object in the visual field and the factors that determine it. The article reports the methods of oculographic examination, with special emphasis on the non-invasive technique using corneal reflections, and the criteria for optimal selection of the test apparatus for drivers in experimental conditions (on a driving simulator) and in real conditions. Particular attention was also paid to the helmet - or glass-type devices provided with 1 or 2 high definition (HD) camcorders recording the field of vision and the direction of gaze, and the non-contact devices comprising 2 or 3 cameras and an infrared source to record eye and head movements, pupil diameter, eye convergence distance, duration and frequency of eyelid blinking. A review of the studies conducted using driver eye-tracking procedure was presented. The results, in addition to their cognitive value, can be used with success to optimize the strategy of drivers training.

The analysis of influence of individual and environmental factors on 2-wheeled users' injuries

OBJECTIVE

Powered 2-wheeled motor vehicles (PTWs) are one of the most vulnerable categories of road users. Bearing that fact in mind, we have researched the effects of individual and environmental factors on the severity and type of injuries of PTW users. The aim was to recognize the circumstances that cause these accidents and take some preventive actions that would improve the level of road safety for PTWs.

METHODS

In the period from 2001 to 2010, an analysis of 139 road accidents involving PTWs was made by the Faculty of Transport and Traffic Engineering in Belgrade. The effects of both individual (age, gender, etc.) and environmental factors (place of an accident, time of day, etc.) on the cause of accidents and severity and type of injuries of PTWs are reported in this article. Analyses of these effects were conducted using logistic regression, chi-square tests, and Pearson's correlation.

RESULTS

Factors such as categories of road users, pavement conditions, place of accident, age, and time of day have a statistically significant effect on PTW injuries, whereas other factors (gender, road type; that is, straight or curvy) do not. The article also defines the interdependence of the occurrence of particular injuries at certain speeds. The results show that if PTW users died of a head injury, these were usually concurrent with chest injuries, injuries to internal organs, and limb injuries.

CONCLUSIONS

It has been shown that there is a high degree of influence of individual factors on the occurrence of accidents involving 2-wheelers (PTWs/bicycles) but with no statistically significant relation. Establishing the existence of such conditionalities enables identifying and defining factors that have an impact on the occurrence of traffic accidents involving bicyclists or PTWs. Such a link between individual factors and the occurrence of accidents makes it possible for system managers to take appropriate actions aimed at certain categories of 2-wheelers in order to reduce casualties in a particular area. The analysis showed that most of the road factors do not have a statistically significant effect on either category of 2-wheeler. Namely, the logistic regression analysis showed that there is a statistically significant effect of the place of accident on the occurrence of accidents involving bicyclists.

A new approach for the assessment of sleepiness and predictivity of obstructive sleep apnea in drivers: A pilot study

BACKGROUND

Falling asleep behind the wheel is one of the most relevant consequences of obstructive sleep apnea (OSA). We created a new screening questionnaire, named the Driver Sleepiness Score (DSS), aiming to assess sleepiness in drivers with suspected OSA. The primary aim of our study was to evaluate sleepiness in drivers with a suspicion of OSA by the DSS in order to assess its correlation with the apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and total sleep time with oxyhemoglobin saturation below 90% (TST90). We also aimed to assess the diagnostic accuracy of DSS for three different cutoffs of AHI (AHI = 5, AHI = 15, AHI = 30), which allow stratification of the severity of OSA.

MATERIALS AND METHODS

Seventy-three driving patients at risk for OSA participated in the study. DSS and the Epworth Sleepiness Scale (ESS) were both administered in operator-dependent modality and in randomized sequence.

RESULTS

The DSS showed higher accuracy in screening patients with mild OSA [area under curve (AUC): 0.88 vs 0.74] and moderate OSA (AUC: 0.88 vs 0.79), whereas ESS showed higher accuracy in screening patients with severe OSA (AUC: 0.91 vs 0.78). A DSS score ≥ 7 is the optimal cutoff for distinguishing true positives from false positives for the presence of OSA and for its different severity levels. The administration of both questionnaires increases the accuracy for the detection of all OSA severity levels.

CONCLUSIONS

If validated, DSS may qualify as a new screening tool specifically for drivers with the suspicion of having OSA, in combination with the ESS.

Rapid Assessment of Environmental Health Impacts for Policy Support: The Example of Road Transport in New Zealand

An integrated environmental health impact assessment of road transport in New Zealand was carried out, using a rapid assessment. The disease and injury burden was assessed from traffic-related accidents, air pollution, noise and physical (in)activity, and impacts attributed back to modal source. In total, road transport was found to be responsible for 650 deaths in 2012 (2.1% of annual mortality): 308 from traffic accidents, 283 as a result of air pollution, and 59 from noise. Together with morbidity, these represent a total burden of disease of 26,610 disability-adjusted life years (DALYs). An estimated 40 deaths and 1874 DALYs were avoided through active transport. Cars are responsible for about 52% of attributable deaths, but heavy goods vehicles (6% of vehicle kilometres travelled, vkt) accounted for 21% of deaths. Motorcycles (1 per cent of vkt) are implicated in nearly 8% of deaths. Overall, impacts of traffic-related air pollution and noise are low compared to other developed countries, but road accident rates are high. Results highlight the need for policies targeted at road accidents, and especially at heavy goods vehicles and motorcycles, along with more general action to reduce the reliance on private road transport. The study also provides a framework for national indicator development.

How Thailand's greater convergence created sustainable funding for emerging health priorities caused by globalization

Background

Global health is shifting gradually from a limited focus on individual communicable disease goals to the formulation of broader sustainable health development goals. A major impediment to this shift is that most low- and middle-income countries (LMICs) have not established adequate sustainable funding for health promotion and health infrastructure.

Objective

In this article, we analyze how Thailand, a middle-income country, created a mechanism for sustainable funding for health.

Design

We analyzed the progression of tobacco control and health promotion policies over the past three decades within the wider political-economic and sociocultural context. We constructed a parallel longitudinal analysis of statistical data on one emerging priority – road accidents – to determine whether policy shifts resulted in reduced injuries, hospitalizations and deaths.

Results

In Thailand, the convergence of priorities among national interest groups for sustainable health development created an opportunity to use domestic tax policy and to create a semi-autonomous foundation (ThaiHealth) to address a range of pressing health priorities, including programs that substantially reduced road accidents.

Conclusions

Thailand's strategic process to develop a domestic mechanism for sustainable funding for health may provide LMICs with a roadmap to address emerging health priorities, especially those caused by modernization and globalization.

Drug Use among Iranian Drivers Involved in Fatal Car Accidents

BACKGROUND

Although the problem of substance use among drivers is not limited to certain parts of the world, most epidemiological reports on this topic have been published from industrial world.

AIM

To investigate pattern of drug use among Iranian drivers who were involved in fatal road accidents.

METHODS

This study enrolled 51 Iranian adults who were involved in fatal vehicle accidents and were imprisoned thereafter. Data came from a national survey of drug abuse that was done among Iranian prisoners. The survey collected data at the entry to seven prisons in different regions of the country during a 4-month period in 2008. Self-reported lifetime, last year, and last month drug use was measured. Commercial substance screening tests were applied to detect recent substance use (opioids, cannabinoids, methamphetamines, and benzodiazepines).

RESULTS

The commercial substance screening test showed three distinct patterns of recent illicit drug use: opioids (37.3%), cannabinoids (2.0%), opioids and cannabinoids (13.7%). 29.4% were also positive for benzodiazepines. The substance use screening test detected 23.5% of participants who had used drugs but did not disclose any substance use.

CONCLUSION

Opioids are the most common illicit drugs being used by Iranian drivers who are involved in fatal car accidents. The high rate of substance use prior to fatal car accidents in Iran advocates for the need for drug use control policies and programs as major strategies for injury prevention in Iran. There is also a need for substance screening among all drivers involved in fatal car accidents in Iran, as more than 20% of users may not disclose substance use.

The role of sleepiness, sleep disorders, and the work environment on heavy-vehicle crashes in 2 Australian states

Heavy-vehicle driving involves a challenging work environment and a high crash rate. We investigated the associations of sleepiness, sleep disorders, and work environment (including truck characteristics) with the risk of crashing between 2008 and 2011 in the Australian states of New South Wales and Western Australia. We conducted a case-control study of 530 heavy-vehicle drivers who had recently crashed and 517 heavy-vehicle drivers who had not. Drivers' crash histories, truck details, driving schedules, payment rates, sleep patterns, and measures of health were collected. Subjects wore a nasal flow monitor for 1 night to assess for obstructive sleep apnea. Driving schedules that included the period between midnight and 5:59 am were associated with increased likelihood of crashing (odds ratio = 3.42, 95% confidence interval: 2.04, 5.74), as were having an empty load (odds ratio = 2.61, 95% confidence interval: 1.72, 3.97) and being a less experienced driver (odds ratio = 3.25, 95% confidence interval: 2.37, 4.46). Not taking regular breaks and the lack of vehicle safety devices were also associated with increased crash risk. Despite the high prevalence of obstructive sleep apnea, it was not associated with the risk of a heavy-vehicle nonfatal, nonsevere crash. Scheduling of driving to avoid midnight-to-dawn driving and the use of more frequent rest breaks are likely to reduce the risk of heavy-vehicle nonfatal, nonsevere crashes by 2-3 times.

Greasy roads: the impact of bad financial news on road traffic accidents

We use evidence from a natural experiment in Greece to study the effect of the announcement of austerity measures on road traffic accidents (RTAs). We use daily RTA data from 2010 and 2011, during which a number of austerity measures were announced, including salary and pension cuts and an increase in direct and indirect taxes. We find that controlling for other factors potentially influencing RTAs, the number of RTAs increased significantly on the first two days following the announcements of austerity measures. We put forward some tentative suggestions for why this happens.

Investigating the predictive of risk-taking attitudes and behaviors among Iranian drivers

BACKGROUND

World Health Organization findings shows that up to year 2020 the number of fatality due to driving accidents will increases up to 65%, which is 80% is in developing countries. Iran has one of the highest rates of road traffic accident mortality rate in the world.

MATERIALS AND METHODS

The cross-sectional study was carried out in the center and west of Iran upon 540 ordinary and taxi drivers who were driving regularly from bus terminals and the travel agencies to other cities. Data collection tool is a questionnaire that measuring driving risk taking by two items of risky driving behaviors and risk taking attitudes.

FINDINGS

The results of this study showed that the averages of risk driving behaviors scores were higher than the average of risk taking attitudes scores. The results of logistic regression test showed that the risky driving behaviors can be a predictor of driving accidents due to individuals' risk taking (P = 0.014). Among all these variables, attitude toward rule violations and speeding, aggressive driving and violation of the road laws respectively are important predictive of drivers' risk taking (P < 0.0010).

DISCUSSION AND CONCLUSION

Although attitude toward risk taking has been located at a low level by different ways, a desired result was not obtained from the reduction of those high risky behaviors; in fact, high-rate of accidents and traffic incidence in Iran indicates this matter well.

Aging and nocturnal driving: better with coffee or a nap? A randomized study

STUDY OBJECTIVE

To test the effects of coffee and napping on nocturnal driving in young and middle-aged participants.

DESIGN

A cup of coffee (200 mg of caffeine), a placebo (decaffeinated coffee, 15 mg of caffeine), or a 30-minute nap were tested. Participants drove 125 highway miles between 18:00 and 19:30 and between 02:00 and 03:30 after coffee, placebo, or a nap.

SETTING

Sleep laboratory and open French highway.

PARTICIPANTS

Twelve young (range, 20-25 years) and 12 middle-aged participants (range, 40-50 years).

MEASUREMENTS

Inappropriate line crossings, self-perceived fatigue and sleepiness, and polysomnographic recordings were analyzed.

RESULTS

Compared to daytime, after placebo the number of inappropriate line crossings was significantly increased (2 versus 73 for young participants, P < 0.01 and 0 versus 76 for the middle-aged participants, P < 0.05). Both coffee and napping reduced the risk of inappropriate line crossings, compared with placebo, in young participants (respectively, by three-quarters, incidence rate ratios [IRR] = 0.26 95% confidence interval [CI], 0.09-0.74, P < 0.05 and by two thirds, IRR = 0.34 95% CI, 0.20-0.58, P < 0.001) and in middle-aged participants (respectively by nine tenths, IRR = 0.11 95% CI, 0.05-0.21, P < 0.001 and by one fifth, IRR = 0.77 95% CI, 0.63-0.95, P < 0.05). A significant interaction between age and condition (IRR = 2.27 95% CI, 1.28-4.16 P < 0.01) showed that napping led to fewer inappropriate line crossings in younger participants than in middle-aged participants. During napping, young participants slept more (P < 0.01) and had more delta sleep (P < 0.05) than middle-aged participants. Self-perceived sleepiness and fatigue did not differ in both age groups, but coffee improved sleepiness (P < 0.05), whereas napping did not.

CONCLUSIONS

Coffee significantly improves performance in young and middle-aged participants. Napping is more efficient in younger than in older participants. Countermeasures to sleepiness should be adapted according to the age of drivers.

Review of global menace of road accidents with special reference to malaysia- a social perspective

Road accident is 'a global tragedy' with ever-rising trend. The goal of this article includes review of the causes and nature of accidents, statistical data regarding road accidents and the economical impact. 1.17 million deaths occur each year worldwide due to road accidents 70 % of which occur in developing countries. 65% of deaths involve pedestrians, 35 % of which are children. Estimates suggest that 23-34 million people are injured worldwide every year in road crashes - a value almost twice that previously estimated. It is estimated that more than 200 U.S. citizens die each year due to road accidents abroad. Every year in Europe, more than 50,000 peoples are killed in road accidents, and more than 150,000 remain disabled. It is a sad fact that the total number of road accidents in Malaysia exceeded 223,000 in 1999. On the average, 16 persons died from these road accidents, every single day in 1999. Lack of attention, reckless driving, lack of proper protection, speeding, bad personal habits, social and behavioral misconduct and inconsiderate drivers of larger vehicles are some of the problems that cause accidents. In Malaysia, motorcycle fatal accidents (60%) warrant a high degree of concern. Young children and senior citizens are found to be in the vulnerable age group. In Malaysia, in 1999 alone, general insurers paid RM1.67 billion or an average of RM4.6 million a day on motor claims. It is now recognized that road traffic accidents represent a major public health problem, because of the high number of victims involved and because of the seriousness of the consequences for themselves and for their families.

Lens lesions in the elk

During the period 1973–1976, eyes from 17 elks (Alces a. alces L) were examined, bilateral cataract being found in nine elks, and a cataract found in an additional elk, from which only one eye was submitted for examination. Macro-scopically, the lenses were more or less deformed and reduced in size, being milky white or brownish grey and shrunk, their surface uneven and granular. Microscopically, there was a marked fluid accumulation between the lens fibers and apparently also a swelling of the lens fibers. Proliferation and swelling of epithelial cells were observed as well. Etiological factors are discussed.