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Abstract.Driving anxiety is a common experience that, for those with high levels of driving anxiety, can markedly interfere with functioning, particularly because of avoidance behavior. The Driving and Riding Avoidance Scale (DRAS; Stewart & St. Peter, 2004) is a promising measure of self-reported avoidance, but its psychometric properties have been questioned as the instructions do not specifically ask respondents to report avoidance that is due to driving anxiety. The present study investigated the psychometric properties of the DRAS using revised instructions in 437 participants from the general population of New Zealand. Internal consistency for the DRAS was 0.94 and ranged from 0.79 to 0.90 for the four subscales. A two-factor solution was supported, in line with previous research using the revised instructions, supporting the distinction between general and traffic avoidance compared with weather and riding avoidance. Further work on the psychometric properties of this measure with clinical samples is needed to clarify the subscale structure.

ObjectiveThis study reported the burden of gout and its attributable risk factors in the Middle East and North Africa (MENA) region between 1990 and 2019 by age, sex, and sociodemographic index (SDI).MethodsData on the prevalence, incidence, and years lived with disability (YLD) due to gout were obtained from the Global Burden of Disease 2019 study for the 21 countries in the MENA region, from 1990 to 2019.ResultsIn 2019, the regional age-standardized point prevalence and annual incidence rates of gout were 509.1 and 97.7 per 100,000 population, which represent a 12% and 11.1% increase since 1990, respectively. Moreover, in 2019 the regional age-standardized YLD rate was 15.8 per 100,000 population, an 11.7% increase since 1990. In 2019, Qatar and Afghanistan had the highest and lowest age-standardized YLD rates, respectively. Regionally, the age-standardized point prevalence of gout increased with age up to the oldest age group, and it was more prevalent among males in all age groups. In addition, there was an overall positive association between SDI and the burden of gout between 1990 and 2019. In 2019, high BMI (46.1%) was the largest contributor to the burden of gout in the MENA region.ConclusionThere were large intercountry variations in the burden of gout, but in general, it has increased in MENA over the last 3 decades. This increase is in line with the global trends of gout. However, the age-standardized YLD rate change was higher in MENA than at the global level.

Understanding global trends in the point prevalence, deaths, and disability-adjusted life-years (DALYs) for asthma will facilitate evidence-based decision-making.

Objectives: To perform a meta-analysis on the relationship type 2 diabetes has with serum hepcidin and the hepcidin/ferritin ratio. Methods: The following databases were searched using all relevant keywords: Web of Science, Medline, Scopus, Embase and Google Scholar. All studies that examined the relationship type 2 diabetes has with serum hepcidin or the hepcidin/ferritin ratio were included in this meta-analysis and systematic review provided, were published in English between 2011 and 2018. A random-effects model was used to pool the standardized mean difference (SMD). Results: The SMD of serum hepcidin among patients with type 2 diabetes and healthy controls were compared across eight studies (n cases=878; n controls=2306). The pooled SMD of serum hepcidin did not differ significantly between study groups (SMD: 0.04; 95% confidence interval (CI): -0.29 to 0.35). In contrast, the serum hepcidin/ferritin ratio was examined across five studies (n cases=229; n controls=1426) and was found to be negatively associated with the risk of type 2 diabetes (SMD: -0.52; 95% confidence interval (CI): -0.85 to -0.19). There was no publication bias found for the associations serum hepcidin (Egger´s test: P =0.97) or the hepcidin/ferritin ratio (Egger´s test: P =0.75) had with type 2 diabetes. Conclusion: Although hepcidin has been proposed as a risk marker for type 2 diabetes, our metaanalysis found that the hepcidin/ferritin ratio was superior to hepcidin alone as a risk marker.

Aim: Although it is currently legal in Poland to use a hands-free mobile phone while driving, research suggests that it is not significantly safer than using a hand-held mobile phone. The present study used the theory of planned behaviour (TPB) to examine the relationships that three types of beliefs (behavioural, normative and control beliefs) have with the frequency of drivers’ hands-free and hand-held mobile phone use. Subjects and methods: The sample comprised 298 Polish drivers (35% females) aged between 18 and 40 years old (mean age: 21.05 years, standard deviation?=?2.38). Results: Two multivariate analyses of variance (MANOVAs) were conducted to investigate the differences between the two groups (hand-held and hands-free) of frequent and infrequent mobile phone users, with regard to their behavioural, normative and control beliefs. Significant differences were found in all of the control beliefs for both hand-held and hands-free mobile phone users. Similar normative differences were identified for both hands-free and hand-held mobile phone use, but while three behavioural beliefs differed significantly for hands-free use, no behavioural beliefs were significant for hand-held mobile phone use. Finally, composite measures of the behavioural and control beliefs were predictive of being a frequent hand-held mobile phone user, but none of the three beliefs were predictive of being a frequent hands-free user. Conclusions: These results demonstrate potential directions for behavioural change aimed at reducing or preventing the use of mobile phones while driving.

AbstractDriving is the riskiest work-related activity in the European Union, including the UK. One promising approach for improving work-related driver safety is through the use of In-Vehicle Data Monitors (IVDM), but the majority of the studies on this topic have substantial methodological short comings or found no significant effect. The present study investigated whether providing feedback, that was formulated according to established guidelines, would result in an improvement in safety behaviours among sales representatives over an 8.5 month period. The results showed that the treatment group engaged in significantly less risky driving behaviours per 100 kms during the intervention period, than during the baseline, while there was no significant difference for the control group. Furthermore, seatbelt use was significantly higher for the treatment group during the intervention period, while the control group demonstrated a significant decrease in seatbelt use in the treatment period, when compared with the baseline.

Data about the global, regional, and country-specific variations in the levels and trends of colorectal cancer are required to understand the impact of this disease and the trends in its burden to help policy makers allocate resources. Here we provide a status report on the incidence, mortality, and disability caused by colorectal cancer in 195 countries and territories between 1990 and 2017.

Background: The loss of vision is a substantial public health concern that has important implications for an individual’s quality of life. The primary objective of this research was to document the burden of vision loss in the Middle East and North Africa (MENA) region, spanning the years 1990–2019, by age group, sex, underlying cause and sociodemographic index (SDI). Methods: Publicly available data concerning the burden of vision loss were acquired from the Global Burden of Disease study 2019. The data encompassed all 21 countries within the MENA region for the period spanning 1990 to 2019. The estimates were reported as raw counts and age-standardised rates per 100,000, accompanied by their corresponding 95% uncertainty intervals (UIs). Results: In 2019, MENA had an age-standardised point prevalence of 7040.0 (95% UI: 6195.0, 8002.7) and an YLD rate of 314.5 (222.1, 427.6) per 100,000 for vision loss, which were 11.1% (-12.5, -9.7) and 24.3% (-27.6, -20.8) lower, respectively, than in 1990. In 2019, Afghanistan [469.6 (333.0, 632.8)] had the largest age-standardised YLD rate and Turkey [210.7 (145.3, 290.9)] had the lowest. All countries showed a decrease in the age-standardised point prevalence and YLD rate between 1990 and 2019, except for Oman, Afghanistan, and Yemen. Furthermore, in 2019 the largest number of prevalent cases and YLDs were found in the 65–69 age group. Also in 2019, the age-standardised YLD rates in MENA exceeded the global averages for most age groups, for both males and females. In 2019, refractive disorders were the most common types of vision loss among children, adolescents, and middle-age adults in MENA, while near vision loss and cataracts were the most common among older adults. Finally, the burden of vision loss had a slightly negatively association with SDI over the period 1990–2019. Conclusion: Although the burden of vision loss has decreased over the last three decades, the prevalence remains high. These results underscore the importance of healthcare policymakers taking action to implement preventive measures, especially among the elderly and those living in low socioeconomic countries, to decrease the attributable burden in MENA.

This study investigated the frequency of mobile phones use while driving by mode (handheld vs. hands-free users) and its relationship with three types of beliefs (behavioural, normative and control).

In present-day highly-automated vehicles, there are occasions when the driving system disengages and the human driver is required to take-over. This is of great importance to a vehicle &#x02BC s safety and ride comfort. In the U.S state of California, the Autonomous Vehicle Testing Regulations require every manufacturer testing autonomous vehicles on public roads to submit an annual report summarizing the disengagements of the technology experienced during testing. On 1 January 2016, seven manufacturers submitted their first disengagement reports: Bosch, Delphi, Google, Nissan, Mercedes-Benz, Volkswagen, and Tesla Motors. This work analyses the data from these disengagement reports with the aim of gaining abetter understanding of the situations in which a driver is required to takeover, as this is potentially useful in improving the Society of Automotive Engineers &#x0028 SAE &#x0029 Level 2 and Level 3 automation technologies. Disengagement events from testing are classified into different groups based on attributes and the causes of disengagement are investigated and compared in detail. The mechanisms and time taken for take-over transition occurred in disengagements are studied. Finally, recommendations for OEMs, manufacturers, and government organizations are also discussed.

Bicycle helmets protect against serious brain injuries caused by bicycle accidents. One strategy to increase helmet use is via mass media campaigns. This study systematically reviewed the effectiveness of mass media campaigns which aimed to increase bicycle helmet use.

Background: Anorexia nervosa (AN) is a complex and heritable psychiatric disorder, which imposes significant mortality and morbidity on sufferers globally. We aimed to report the prevalence, incidence and disability-adjusted life-years (DALYs) attributable to AN in the Middle East and North Africa (MENA) region by age, sex and socio-demographic index (SDI), between 1990 and 2019. Methods: The disease burden attributable to AN was obtained for the 21 countries located in the MENA region between 1990 and 2019 using publicly available data from the Global Burden of Disease (GBD) 2019 study. All estimates were provided as counts and age-standardized rates per 100,000 population, along with 95% uncertainty intervals (UIs). Results: In 2019, the estimated age-standardised point prevalence and incidence rate of AN (per 100,000) in MENA were 49.3 (95% UI: 34.6–70.4) and 16.0 (11.3–22.0), which were 11.4% (7.3–15.4) and 5.9% (2.6–9.1) higher than in 1990, respectively. Furthermore, the regional age-standardised DALY rate was 10.6 (6.3–17.0) per 100,000 in 2019, which was 11.8% (5.2–19.1) higher than in 1990. In 2019, Kuwait [17.3 (10.3-27.9)] and Afghanistan [6.3 (3.7-10.3)] had the highest and lowest age-standardised DALY rates, respectively. In addition, Iran showed the largest increases in the age-standardised point prevalence [30.0% (24.1–36.2)], incidence [24.6% (18.6–30.4)] and DALY [30.5% (22.6–38.9)] rates between 1990 and 2019. In 2019, the number of prevalent cases and prevalence estimates peaked in the 15–19 age group for males and the 20–24 age group for females, with females having a higher number of cases and prevalence in all age groups. In 2019, the age-standardised DALY rates in MENA were higher than the global rates among males aged 10–34 years, but were lower than the global estimates among females in almost all age groups. In addition, the burden of AN was positively associated with the level of socio-economic development during the measurement period. Conclusions: The burden of AN in the MENA region increased between 1990 and 2019, which indicates that it is likely to become a more serious public health issue in the future. Up-to-date information about the epidemiological trends in the region would allow health policymakers to make informed and appropriate decisions to help address this issue. Plain English summary: The findings of the present study showed that the point prevalence and incidence rate of anorexia nervosa have increased in the Middle East and North Africa region between 1990 and 2019. The highest burden in 2019 was found in Kuwait, while Afghanistan had the lowest attributable burden. In addition, between 1990 and 2019 Iran had the largest increase in the point prevalence of anorexia nervosa. Also in 2019, anorexia nervosa was more prevalent in females and peaked in the 15–19 age group for males and the 20–24 age group for females. Furthermore, as the level of socioeconomic development increased, so did the burden attributable to anorexia nervosa.

Background: There is no region-specific publication investigating the attributable burden of breast cancer, particularly among females. This article reported the burden of female breast cancer in the Middle East and North Africa (MENA) region, and its attributable risk factors between 1990 and 2019, by age, sex, and socio-demographic index (SDI). Methods: Publicly available data on the incidence, death and disability-adjusted life years (DALY) were retrieved from the Global Burden of Disease (GBD) 2019 study for the 21 countries and territories in MENA, between 1990 and 2019, along with 95% uncertainty intervals (UIs). The relationship between the burden of female breast cancer, in terms of DALYs, and the SDI were also assessed using Smoothing Spline models. Results: In 2019, the regional age-standardised incidence and death rates of female breast cancer were 37.5 and 15.2 per 100,000, which represent a 90.9 and 24.0% increase since 1990, respectively. In addition, in 2019 the regional age-standardised DALY rate was 472.7 per 100,000, which was 19.5% higher than in 1990. In 2019, the death rate increased steadily with advancing age, while the DALY rate increased steeply with age and reached its peak in the 70–74 age group. There was a positive association between SDI and the burden of breast cancer over the period 1990 to 2019. Moreover, in 2019 high fasting plasma glucose (6.9%) contributed to the largest proportion of attributable DALYs for female breast cancer in the MENA region. Conclusions: There was a significant increase in the incidence rate of female breast cancer in MENA over the past three decades, although the death and DALY rates were both largely unchanged. Preventive programs targeting the major risk factors should be implemented in the region.

ABSTRACTAt the beginning of the current pandemic, it was believed that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection would induce lifelong immunity and that reinfections would be unlikely. However, after several cases of reinfection were documented in previously infected patients, this was understood to be a false assumption, and this waning humoral immunity has raised significant concerns. Accordingly, long-term and durable vaccine-induced antibody protection against infection have also become a challenge, as several breakthroughs of COVID-19 infection have been identified in individuals who were fully vaccinated. This review discusses the current evidence on breakthrough COVID-19 infections occurring after vaccination.

ABSTRACTThe emergence of SARS-CoV-2 has led to the infection of many people across the globe, over six million deaths, and has placed an unprecedented burden on public health worldwide. The pandemic has led to the high-speed development and production of vaccines against the COVID-19, as vaccines can end the pandemic. At the beginning of the program, vaccinations were initially targeted only at high-risk groups, such as the elderly, those with comorbidities, or healthcare workers. Although most of the mentioned populations have received the two recommended doses, limited resources have left many authorities with an effective vaccine undersupply. Therefore, policies have been implemented to manage the available doses of the vaccines more efficiently. As there is no universally agreed consensus on this topic, we discuss the different recommendations and guidelines regarding the time interval between the two vaccine doses and explain the different scenarios for applying the two doses.

ObjectiveTo report the global, regional, and national burden of chronic obstructive pulmonary disease (COPD) and its attributable risk factors between 1990 and 2019, by age, sex, and sociodemographic index.DesignSystematic analysis.Data sourceGlobal Burden of Disease Study 2019.Main outcome measuresData on the prevalence, deaths, and disability adjusted life years (DALYs) of COPD, and its attributable risk factors, were retrieved from the Global Burden of Disease 2019 project for 204 countries and territories, between 1990 and 2019. The counts and rates per 100 000 population, along with 95% uncertainty intervals, were presented for each estimate.ResultsIn 2019, 212.3 million prevalent cases of COPD were reported globally, with COPD accounting for 3.3 million deaths and 74.4 million DALYs. The global age standardised point prevalence, death, and DALY rates for COPD were 2638.2 (95% uncertainty intervals 2492.2 to 2796.1), 42.5 (37.6 to 46.3), and 926.1 (848.8 to 997.7) per 100 000 population, which were 8.7%, 41.7%, and 39.8% lower than in 1990, respectively. In 2019, Denmark (4299.5), Myanmar (3963.7), and Belgium (3927.7) had the highest age standardised point prevalence of COPD. Egypt (62.0%), Georgia (54.9%), and Nicaragua (51.6%) showed the largest increases in age standardised point prevalence across the study period. In 2019, Nepal (182.5) and Japan (7.4) had the highest and lowest age standardised death rates per 100 000, respectively, and Nepal (3318.4) and Barbados (177.7) had the highest and lowest age standardised DALY rates per 100 000, respectively. In men, the global DALY rate of COPD increased up to age 85-89 years and then decreased with advancing age, whereas for women the rate increased up to the oldest age group (≥95 years). Regionally, an overall reversed V shaped association was found between sociodemographic index and the age standardised DALY rate of COPD. Factors contributing most to the DALYs rates for COPD were smoking (46.0%), pollution from ambient particulate matter (20.7%), and occupational exposure to particulate matter, gases, and fumes (15.6%).ConclusionsDespite the decreasing burden of COPD, this disease remains a major public health problem, especially in countries with a low sociodemographic index. Preventive programmes should focus on smoking cessation, improving air quality, and reducing occupational exposures to further reduce the burden of COPD.

AbstractHazards occurring to the fallers and chokersetters (breaker-outs) within cable yarder (hauler) crews working in windthrow salvage conditions were recorded. Fallers were exposed to considerably more and potentially more serious hazards than fallers working under normal conditions. The most hazardous parts of the faller’s job were those of felling, clearing around the tree to be felled and clearing a path to the tree to be felled. The two most dangerous tree types to deal with were “hung-up” and “rootball trees”. The choker setters were exposed to a similar number of hazards per cycle as choker setting in normal conditions, but a number of previously undocumented hazards were recorded. The majority of choking hazards (70%) occurred during the “wait” phase of choking with the most frequent hazard being “standing within one tree length of the turn ”. The information contained in this article may assist other contractors and forest companies faced with the difficult task of harvesting windthrown trees.

Work within the New Zealand logging industry is recognised as being dangerous and physically demanding, with relatively high accident and injury frequency rates. As a consequence, the financial cost of accidents to the New Zealand Accident Rehabilitation and Compensation Insurance Corporation (ACC), and ultimately the logging industry, is extremely high. One method of reducing this cost is to achieve an early return to work through the use of rehabilitation techniques. Some rehabilitation techniques are already being used by logging and transportation contractors; these could be increased and diversified with help from the ACC (the New Zealand injury insurance scheme) which currently offers a variety of rehabilitation options. This report presents a number of contractor and worker initiated rehabilitation case studies, as well as two examples of how the ACC can provide financial assistance to achieve an early return to work.