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• This study innovatively used quasi-induced exposure methods with novel community-level indicators of vulnerability to estimate the prevalence of New Jersey drivers being unbelted during vehicle trips. • Overall, this study found driver's seat belt non-use to be 1.2% between 2010–2017, which is lower than the previously estimated rate of 8.3% over similar years. • Seat belt non-use was 122% more prevalent in communities with the largest percentage of the population living with three or more indicators of vulnerability than communities with the smallest percentage of the population living with three or more indicators of vulnerability. Introduction: Examining crash reports with linked community-level indicators may optimize efforts aimed at improving traffic safety behaviors, like seat belt use. To examine this, quasi-induced exposure (QIE) methods and linked data were used to (a) estimate trip-level seat belt non-use of New Jersey (NJ) drivers and (b) determine the degree to which seat belt non-use is associated with community-level indicators of vulnerability. Method: Driver-specific characteristics were identified from crash reports (age, sex, number of passengers, vehicle type) and licensing data (license status at the time of the crash). Geocoded residential addresses were leveraged within the NJ Safety and Health Outcomes warehouse to create quintiles of community-level vulnerability. QIE methods were applied to estimate trip-level prevalence of seat belt non-use in non-responsible, crash-involved drivers between 2010–2017 (n = 986,837). Generalized linear mixed models were then conducted to calculate adjusted prevalence ratios and 95 % confidence intervals for being unbelted for driver-specific variables and community-level indicators of vulnerability. Results: Drivers were unbelted during 1.2 % of trips. Males, those with suspended licenses, and those without passengers had higher rates of being unbelted than their counterparts. An increase was observed in traveling unbelted with increasing quintiles of vulnerability, such that drivers in the most vulnerable communities were 121 % more likely to be unbelted than those in the least vulnerable communities. Conclusions: Prevalence of driver seat belt non-use may be lower than previously estimated. Additionally, communities with the highest amount of the population living with three or more indicators of vulnerability have higher rates of seat belt non-use; this may be a particularly useful metric to inform future translational efforts improving seat belt use. Practical Applications: As evidenced by the findings that risk of being unbelted increased as drivers' community vulnerability increased, novel communication efforts tailored to drivers from vulnerable neighborhoods may optimize efforts. [ABSTRACT FROM AUTHOR]

• Changes in the risk of road traffic injury in Norway from 1970 to 2022 are described. • Possible explanations of the changes are discussed. • The reporting of injuries in official statistics has declined over time. • A real decline in risk is found after adjusting for incomplete reporting. This paper describes changes in the risk of road traffic injury in Norway during the period from 1970 to 2022. During this period, the risk of fatal and personal injury declined by more than 70 % for most groups of road users. There are five main potential explanations of a decline in the risk of injury: (1) a reduced probability of accidents that have the potential for causing injury; (2) an improved protection against injury given that an accident has occurred; (3) improved medical care increasing the survival rate, given an injury (this would reduce the number of fatalities, but not the number of injuries); (4) a tendency for the reporting of injuries in official accident statistics to decline over time; (5) uncertain or erroneous estimates of the exposure to the risk of injury. The decline in the risk of road traffic injuries in Norway after 1970 can probably be attributed to a combination of reduced reporting of injuries in official statistics, improved protection against injury in accidents, and (for fatal injuries) improved medical care. Insurance data, available from 1992, do not indicate a reduction in the risk of accidents leading to insurance claims. Incomplete and possibly erroneous data for mopeds and motorcycles make it impossible to identify sources of changes in injury risk over time for these modes of transport. [ABSTRACT FROM AUTHOR]

• A community quarantine strategy against coronavirus disease 2019 (COVID-19) was adopted in all urban populations in Anhui. • Community quarantine strategy influenced the injuries distributions in trauma centers. • Community quarantine strategy was effectively implemented and significantly slowed the outbreak of COVID-19 in Anhui. • The implementation and maintenance of the strategy is costly and requires the participation of the entire population. The objective of our study was to introduce community quarantine strategy against coronavirus disease 2019 (COVID-19) in Anhui and evaluate the effectiveness of community quarantine based on trauma center (TC) patients. The structure of community quarantine strategy was illustrated. Distribution of injuries among patients in two TCs between January 24, 2020 and February 24, 2020 was described. Multiple linear regression was used to analyze the correlation between the distribution of Injuries in TCs and the number of COVID-19-associated cases. A total of 757 TC patients in the two hospitals were enrolled. The number of traffic injuries and outdoor injuries showed a significant decrease in the early stage and began to increase on February 17. The number of indoor injuries neither decreased nor increased. Multiple linear regression analysis revealed a significant correlation between COVID-19-associated cases and traffic and outdoor injuries. From the perspective of the injuries in TCs, community quarantine strategy was effectively implemented and significantly slowed the outbreak of COVID-19 in Anhui. However, the implementation and maintenance of the strategy is costly and requires the participation of the entire population. [ABSTRACT FROM AUTHOR]

This study aims to analyze the clinical characteristics, demographic features, and injury circumstances of patients admitted to the Emergency Department (ED) at Fondazione Policlinico Universitario A. Gemelli (IRCCS) in Rome, Italy, due to bicycle accidents. Data on clinical characteristics, accident timing, injury circumstances, and helmet use were collected for ED patients involved in bicycle accidents from January 2019 to December 2022. Subsequently, Abbreviated Injury Scale codes of all diagnoses were recorded and the Injury Severity Score was calculated. Over the study period, 763 patients were admitted to the ED following bicycle accidents, with a 0.3 % fatality rate and a 30.4 % frequency of multitrauma. Multivariate analysis revealed that collisions with other vehicles increased trauma severity and the risk of ICU admission. Conversely, helmet use was associated with reduced severity of head trauma and a lower likelihood of ICU admission. Notably, toxicological investigations were not conducted for any ED-admitted patients. Although a low mortality rate and a low incidence of multi-trauma have been shown in comparison to other nations, it is necessary to adopt prevention strategies like safety devices, more cycle paths, and better infrastructures on the one hand, and stricter laws on the other. It is essential to require toxicological testing in Italy for all accidents involving this means of transport, and to make helmet use compulsory for all ages. [ABSTRACT FROM AUTHOR]

The aim of the study is to increase seat belt (SB) use and reduce motor vehicle (MV) injuries and death; eight tribal communities implemented evidence-based strategies from the Guide to Community Preventive Services during 2010–2014. SB use was measured through direct observational surveys and traffic safety activity data. Traffic safety activities included enhanced enforcement campaign events, ongoing enforcement of SB laws, and media. The number of MV injuries (including fatal and non-fatal) was measured through MV crash data collected by police. Percentage change increases in SB use were observed in all eight projects; average annual increases of three projects were statistically significant (ranging from 10% to 43%). Four of the eight projects exceeded their goals for percentage change increases in SB use. Approximately 200 media events and 100 enforcement events focused on SB use were conducted across the eight projects. Five projects had an annual average of ≥100 SB use citations during the project period. MV injuries (fatal and non-fatal combined) significantly decreased in three projects (ranging from a 10% to 21% average annual decrease). Increases in SB use and decreases in the number of MV injuries can be achieved by tailoring evidence-based strategies to tribal communities. • Four projects exceeded their goals for percentage change increases in seat belt (SB) use. • SB use significantly increased in three projects (10–43% average annual increase). • Motor vehicle (MV) injuries significantly decreased in three projects (10–21% average annual decrease). • Proven strategies to increase SB use and decrease MV injury can be tailored to American Indian/Alaska Native communities. [ABSTRACT FROM AUTHOR]

Highlights • Opioid involved crash deaths significantly increased in Maryland between 2006 and 2017. • Middle-aged, white populations are overrepresented in opioid-involved driver fatalities that are predominantly in rural areas. • Geographic distribution of opioid-involved crash deaths reflect broader patterns of opioid deaths overdose across the state. • Changes in pain management may account for the observed changes in the prevalence opioid-involved crashes. Abstract The objective of this study was to describe trends in the prevalence of opioids in driver fatalities and examine geographic variation in opioid-involved crashes at a county level. Using comprehensive toxicological data from the Office of the Chief Medical Examiner in Maryland, we examined the prevalence of opioids in all motor vehicle crash fatalities in Maryland between 2006–2017 and tested for trends to assess the statistical significance of changes in the prevalence of prescription opioids detected in these drivers over time. Opioid-involved crash deaths accounted for 10.0% of all driver deaths during the study period. The prevalence of opioids detected in fatally injured drivers increased from 8.3% in 2006 to 14.1% in 2017, (Z = −1.9, p <.05). The trends in opioid deaths do not follow broader trends in motor vehicle crash deaths; opioid-involved crashes appear to be increasing while overall motor vehicle crashes appear to be decreasing over the same period. To determine if the increase in opioid-involved crash deaths was the result of changes in pain management related to injuries sustained from the crash, we analyzed a subgroup of cases where death occurred at the scene of the crash. Within this group, there was no statistically significant increase in opioid-involved crashes during the study period. Opioid prevalence was higher in middle aged, and white drivers, and in crashes occurring in rural counties. Geographic distribution of opioid-involved crash deaths reflect broader patterns of opioid deaths overdose across the state. Irrespective of the timing of the deaths, of the drivers testing positive for opioids, 28% had elevated blood alcohol concentrations (‡ 0.01 g/dL), and 45% tested positive for other drugs. [ABSTRACT FROM AUTHOR]

Traffic injuries significantly impact people's psychological, physical and social wellbeing, and involve complex self-regulation responses. Psychological impacts are seldom recognized and addressed holistically. This study employs network analysis to investigate the interconnectedness between different dimensions that influence mental health vulnerability and recovery after traffic injuries. 120 adults with mild-to-moderate traffic injuries and 112 non-injured controls were recruited. The network investigation employed two main approaches. Four cross-sectional networks examined the interrelationships between self-regulation responses (cognitive and autonomic) and various health dimensions (psychological, physical, social) over time (1, 3, 6, 12 months). Three predictive networks explored influences of acute self-regulation responses (1 month) on long-term outcomes. Network analyses focused on between-group differences in overall connectivity and centrality measures (nodal strength). An overall measure of psychological wellbeing consistently emerged as the most central (strongest) node in both groups' networks. Injured individuals showed higher overall connectivity and differences in the centrality of self-regulation nodes compared to controls, at 1-month and 12-months post-injury. These patterns were similarly observed in the predictive networks, including differences in cognitive and autonomic self-regulation influences. Network analyses highlighted the crucial role of psychological health and self-regulation, in promoting optimal wellbeing and effective recovery. Post-traffic injury, increased connectivity indicated prolonged vulnerability for at least a year, underscoring the need of ongoing support beyond the initial improvements. A comprehensive approach that prioritizes psychological health and self-regulation through psychologically informed services, early psychological screening, and interventions promoting cognitive and autonomic self-regulation is crucial for mitigating morbidity and facilitating recovery. Trial registration: IMPRINT study, ACTRN 12616001445460. • Psychological health plays a central role in a person's optimal overall wellbeing. • Cognitive and autonomic self-regulation plays a central role in injury recovery. • Prolonged vulnerability remains for at least a year after a traffic injury. • Prioritizing psychological health as comprehensive approach to holistic recovery. • Cognitive and autonomic self-regulation may be a target to improve recovery. [ABSTRACT FROM AUTHOR]

Highlights • Health impact assessment of long-range transportation plan implementation. • Disaggregate estimates of health benefits from physical activity and traffic injury. • Evaluation of health equity for different race/ethnicity and income groups. Abstract Quantifying the public health impacts of transportation plans provides stakeholders with information that can aid in evaluating alternative transportation scenarios. Active transportation can improve public health through increased physical activity. At the same time, increasing walking and cycling can affect the risk of traffic injury or increase exposure to air pollution. The Integrated Transport and Health Impacts Model (ITHIM) has been applied around the world to understand changes in public health that will result from increases in active travel. However, the model does not provide disaggregate information required to evaluate the social equity implications of such changes. Health benefits are typically reported as a single value (e.g., total reductions in deaths) at the county or regional level. In this work, we draw from several data sources to report demographically explicit (i.e., race/ethnicity and income) results from an ITHIM implementation developed for the Sacramento region in California. This disaggregation is helpful because travel behavior and health outcomes are affected by race/ethnicity and its correlates (e.g., residential location) and planning agencies are required to ensure that their policies and projects are not discriminatory. The results show people of color are generally expected to experience greater overall health benefits than non-Hispanic whites. In addition, the disaggregated results indicate that there is a substantial variation between counties and demographic groups, providing decision makers with the information needed to target interventions to achieve desired outcomes for disadvantaged populations. They also pave the way for further spatial disaggregation. [ABSTRACT FROM AUTHOR]

Background The size of elderly populations is growing in most areas of the world. The Thai Eleventh National Economic and Social Development Plan revealed an increase in the elderly, while numbers of younger, working-age adults decreased. Thailand has become an aging society since 2015, which is significant in that senior adults have a higher risk of involvement in motor vehicle accidents and are more susceptible to injuries and fatalities. This study investigated the role of physical and cognitive function with regard to road traffic injury in senior drivers. Methods A community survey was carried out among people aged 60 years and older in the villages representing four regions of Thailand. Face-to-face interviews and anthropometric measurements were used to gather data including individual characteristics, medical history, risk behaviors, cognitive function and traffic injury within the last 12 months. Associations between risk factors and injury were assessed by the chi-square tests, and comparison of the cognitive function score between the injury and non-injury groups was identified using the independent t-test. Results A total of 314 completed questionnaires were used for analysis. Ten percent of respondents had experienced a road traffic injury in the last 12 months. Analysis revealed that level of cognitive function, smoking behavior and been diagnosed with arthritis were associated with road traffic injury incidence in senior drivers (p-value < 0.05 ). Conclusion Results revealed the potential need for strategies to increase road traffic safety in senior drivers. Special protection should be prioritized for the elderly with physical and cognitive impairment. [ABSTRACT FROM AUTHOR]

Objectives Opioid analgesics are a major driver of the ongoing opioid epidemic in the United Sates, accounting for about two thirds of drug overdose fatalities. There are conflicting reports regarding the effects of prescription opioids on driving safety. A meta -analysis was performed to assess the epidemiologic evidence for the association between use of prescription opioids and the risk of motor vehicle crashes. Methods Studies examining the association between driver prescription opioid use and motor vehicle crash involvement or crash culpability and published in English were identified through a comprehensive search of 15 bibliographic databases. Eligible articles were fully reviewed and summarized. Study quality was assessed using the Newcastle-Ottawa Scale. Overall summary odds ratios (ORs) and 95% confidence intervals (CIs) were estimated through random effects models. Results Overall, 15 studies were included in the meta -analysis; of them, 10 assessed the association of prescription opioid use with the risk of crash involvement and 5 assessed the association of prescription opioid use with the risk of crash culpability. Reported crude ORs associated with prescription opioid use ranged from 1.15 to 8.19 for the risk of crash involvement and from 0.75 to 2.78 for the risk of crash culpability. Summary ORs based on pooled data were 2.29 (95% CI: 1.51, 3.48) for crash risk and 1.47 (95% CI: 1.01, 2.13) for crash culpability. Conclusions The existent epidemiologic evidence indicates that use of prescription opioids by drivers is associated with significantly increased risks of crash involvement and crash culpability. Further research is needed to understand the epidemiologic patterns of prescription opioid use in the driver population and the interaction effects between opioids and alcohol on driving safety. [ABSTRACT FROM AUTHOR]

Objective: The impact of sociodemographic aspects and comorbidities on the inpatient hospital care costs of traffic victims are not clear. The main goal of this study is to provide insights into the sociodemographic characteristics and clinical conditions (including comorbidities) of the victims that result in higher hospital costs.Participants: For the period 2009-2011, people admitted to a hospital as a result of a road traffic crash (N=64,304) were identified in the national Minimal Hospital Dataset, after which they were linked to their respective claims data from the sickness funds.Methods: A generalized linear model was used to analyse hospital costs controlling for roadway user categories, demographics (gender, age, individual socioeconomic status (SES)), and clinical factors (the nature, location, and severity of injury, and comorbidities).Results: The median hospital cost was € 2801 (IQR € 1510-€ 7175, 2015 Euros). There was no significant difference between gender. Low SES inpatients incurred 16% (95% CI: 14%-18%) higher hospital costs than inpatients of high SES. The presence of comorbidities was associated with an increased hospital cost, however with varying magnitude. For example traffic victims suffering from dementia incur significantly higher hospital costs than those who were not (49% higher, 95% CI: 44%-53%), whereas diabetes was associated with a smaller increase in costs compared to non-diabetics (13%, 95% CI: 10%-16%).Conclusion: Comorbidities and low SES are associated with higher hospital costs for traffic victims, notwithstanding their age, and the nature and the severity of their injury. The broad variability of hospital costs among trauma inpatients should be accounted for when reconsidering financing models. Furthermore, the strong predictive value of some comorbidities and SES on hospital costs should be considered when projections of future health care utilisation in traffic safety scenarios are prepared. [ABSTRACT FROM AUTHOR]

Background Motor vehicle emissions contribute nearly a quarter of the world's energy-related greenhouse gases and cause non-negligible air pollution, primarily in urban areas. Changing people's travel behaviour towards alternative transport is an efficient approach to mitigate harmful environmental impacts caused by a large number of vehicles. Such a strategy also provides an opportunity to gain health co-benefits of improved air quality and enhanced physical activities. This study aimed at quantifying co-benefit effects of alternative transport use in Adelaide, South Australia. Method We made projections for a business-as-usual scenario for 2030 with alternative transport scenarios. Separate models including air pollution models and comparative risk assessment health models were developed to link alternative transport scenarios with possible environmental and health benefits. Results In the study region with an estimated population of 1.4 million in 2030, by shifting 40% of vehicle kilometres travelled (VKT) by passenger vehicles to alternative transport, annual average urban PM 2.5 would decline by approximately 0.4 μg/m 3 compared to business-as-usual, resulting in net health benefits of an estimated 13 deaths/year prevented and 118 disability-adjusted life years (DALYs) prevented per year due to improved air quality. Further health benefits would be obtained from improved physical fitness through active transport (508 deaths/year prevented, 6569 DALYs/year prevented), and changes in traffic injuries (21 deaths and, 960 DALYs prevented). Conclusion Although uncertainties remain, our findings suggest that significant environmental and health benefits are possible if alternative transport replaces even a relatively small portion of car trips. The results may provide assistance to various government organisations and relevant service providers and promote collaboration in policy-making, city planning and infrastructure establishment. [ABSTRACT FROM AUTHOR]

Like pedestrians, bicyclists are vulnerable road users, representing a population with a high risk of fatal and severe injuries in traffic accidents as they are unprotected during vehicle collisions. The objective of this study is to investigate the kinematics response of bicyclists and the correlation of the injury severity with vehicle impact speed. Twenty-four car-bicyclist cases with detailed information were selected for accident reconstruction using mathematical models, which was implemented in the MADYMO program. The dynamic response of bicyclists in the typical impact configuration and the correlation of head impact conditions were analyzed and discussed with respect to the head impact speed, time of head impact and impact angle of bicyclists to vehicle impact speed. Furthermore, the injury distribution of bicyclists and the risk of head injuries and fractures of lower limbs were investigated in terms of vehicle impact speed. The results indicate that wrap-around distance (WAD), head impact speed, time of head impact, head impact angle, and throw-out distance (TOD) of the bicyclists have a strong relationship with vehicle impact speed. The vehicle impact speed corresponding to a 50% probability of head AIS 2+ injuries, head AIS 3+ injuries, and lower limb fracture risk for bicyclists is 53.8 km/h, 58.9 km/h, and 41.2 km/h, respectively. A higher vehicle impact speed produces a higher injury risk to bicyclist. The results could provide background knowledge for the establishment or modification of pedestrian regulations considering bicyclist protection as well as being helpful for developing safety measures and protection devices for bicyclists. [ABSTRACT FROM AUTHOR]

Abstract: Background: Brachial plexus injury occurs in up to 5% of polytrauma cases involving motorcycle crashes and in approximately 4% of severe winter sports injuries. One of the conditions for the success of operative therapy is early detection, ideally within three months of injury. The aim of this study was to evaluate associated injuries in patients with severe brachial plexus injury and determine whether there is a characteristic concomitant injury (or injuries), the presence of which, in the polytrauma, could act as a marker for nerve structures involvement and whether there are differences in severity of polytrauma accompanying specific types of brachial plexus injury. Methods: We evaluated retrospectively 84 surgical patients from our department, from 2008 to 2011, that had undergone brachial plexus reconstruction. For all, an injury severity scale (ISS) score and all major associated injuries were determined. Results: 72% of patients had an upper, 26% had a complete and only 2% had a lower brachial plexus palsy. The main cause was motorcycle crashes (60%) followed by car crashes (15%). The average ISS was 35.2 (SD=23.3), although, values were significantly higher in cases involving a coma (59.3, SD=11.0). The lower and complete plexus injuries were significantly associated with coma and fractures of the shoulder girdle and injuries of lower limbs, thoracic organs and head. Upper plexus injuries were associated with somewhat less severe injuries of the upper and lower extremities and less severe injuries of the spine. Conclusion: Serious brachial plexus injury is usually accompanied by other severe injuries. It occurs in high-energy trauma and it can be stated that patients involved in motorcycle and car crashes with multiple fractures of the shoulder girdle are at high risk of nerve trauma. This is especially true for patients in a primary coma. Lower and complete brachial plexus injuries are associated with higher injury severity scale. [Copyright &y& Elsevier]

Abstract: Drugged driving is a serious safety concern, but its role in motor vehicle crashes has not been adequately studied. Using a case-control design, the authors assessed the association between drug use and fatal crash risk. Cases (n =737) were drivers who were involved in fatal motor vehicle crashes in the continental United States during specific time periods in 2007, and controls (n =7719) were participants of the 2007 National Roadside Survey of Alcohol and Drug Use by Drivers. Overall, 31.9% of the cases and 13.7% of the controls tested positive for at least one non-alcohol drug. The estimated odds ratios of fatal crash involvement associated with specific drug categories were 1.83 [95% confidence interval (CI): 1.39, 2.39] for marijuana, 3.03 (95% CI: 2.00, 4.48) for narcotics, 3.57 (95% CI: 2.63, 4.76) for stimulants, and 4.83 (95% CI: 3.18, 7.21) for depressants. Drivers who tested positive for both alcohol and drugs were at substantially heightened risk relative to those using neither alcohol nor drugs (Odds Ratio=23.24; 95% CI: 17.79, 30.28). These results indicate that drug use is associated with a significantly increased risk of fatal crash involvement, particularly when used in combination with alcohol. [Copyright &y& Elsevier]

Abstract: This study evaluated and optimized the performance of a reversible hood (RH) for the prevention of the head injuries of an adult pedestrian from car collisions. The FE model of a production car front was introduced and validated. The baseline RH was developed from the original hood in the validated car front model. In order to evaluate the protective performance of the baseline RH, the FE models of an adult headform and a 50th percentile human head were used in parallel to impact the baseline RH. Based on the evaluation, the response surface method was applied to optimize the RH in terms of the material stiffness, lifting speed, and lifted height. Finally, the headform model and the human head model were again used to evaluate the protective performance of the optimized RH. It was found that the lifted baseline RH can obviously reduce the impact responses of the headform model and the human head model by comparing with the retracted and lifting baseline RH. When the optimized RH was lifted, the HIC values of the headform model and the human head model were further reduced to much lower than 1000. The risk of pedestrian head injuries can be prevented as required by EEVC WG17. [Copyright &y& Elsevier]

Abstract: Objective: In 2003, New York State implemented an enhanced graduated driving licensing (GDL) program that requires extended supervised driving and a passenger restriction. This study examines its safety benefit in 55 Upstate New York counties. Methods: We analyzed fatal/incapacitating traffic injury data among 16-, 17- and 21–24-year olds for the years 2001 and 2005 using the negative binomial model. To adjust for trends in the traffic injury rate, the relative rate ratio (rRR) of 16- and 17-year olds relative to 21–24-year olds was estimated. Results: GDL implementation was associated with a 31% reduction in the driver injury rate (rRR 0.69, 95% confidence interval (CI) 0.49–0.96), but not with any statistically significant change in the passenger injury rate (rRR 1.19, 95% CI 0.77–1.84), or pedestrian and bicyclist injury rate (rRR 1.53, 95% CI 0.89–2.62) among 16-year olds. Sixteen-year olds experienced a 21% decline in licensure rates between 2001 and 2005. GDL implementation had no appreciable impact on driver injury and licensure rates for 17- and 21–24-year olds. Conclusions: GDL implementation is associated with a significant reduction in licensure and driver injury rate among 16-year olds. GDL implementation does not have a statistically significant impact on passenger, pedestrian, and bicyclist injury rates for 16-year olds. [Copyright &y& Elsevier]

Summary: Background: In Vietnam, injury is the leading cause of death in children under 18, and road traffic accidents are the fifth leading cause of death. Information systems for pre-hospital trauma care are insufficient. Objectives: The objective of this study was to assess injury morbidity and mortality, and the existing level of pre-hospital trauma care in Hanoi city. Research design and subjects: A cross-sectional study was conducted in seven districts in Hanoi in 2006. We studied 2800 households (11,334 members), 9 hospitals and an emergency service centre. Results: The injury morbidity rate was 1134/100,000 (year−1), and the injury mortality rate was 23.7/100,000 (year−1). There was no significant difference in age or sex between injury severity levels (p >0.05). Road traffic accidents were the leading cause of injury. Causes of injury mortality differed among different age groups. Only 4% of injured cases were transported to hospital by ambulance. Fifty-two percent of victims did not receive first aid at the site. Pre-hospital trauma care was separately provided by the emergency service centre and hospitals. There was no communication network between the emergency service centre and hospitals, ambulances and hospitals, or between different hospitals. Conclusions: The results reveal that injury is a major health problem in Hanoi and that the pre-hospital care system lacks both coordination and many vital components. Study results may assist decision-makers in identifying interventions to improve health and safety for the population of Hanoi. [Copyright &y& Elsevier]

Abstract: In many developing urban settings, economic growth and motorization are coupled with increasing rates of road traffic injuries (RTIs). By highlighting typical sites and circumstances at/in which car crashes occur, more specific targets for prevention can be identified. The study is based on police data for a 1-year period and covers the Chaoyang District, the biggest district of Beijing City. Focus is placed on crash patterns and their distribution by types of road and areas. Both fatal and non-fatal crashes are considered (n =754). In the main, the crashes occurred in relatively favorable driving circumstances (e.g., sunny weather, flat and straight roads, asphalted roads, and good traffic signals and road markings). They were also quite evenly distributed over time of day, day of week and season. Five crash patterns were highlighted, of which three were strongly associated with specific areas and four with specific types of road. The study supports the idea that type of road and RTI severity or pattern are closely related. It contributes to the development of context-relevant prevention measures aimed at reducing road crashes and minimizing their consequences and also supports safe planning of the road traffic environment. [Copyright &y& Elsevier]

Abstract: Objective: Carisoprodol, a drug used for acute lower back pain, may cause psychomotor impairment. We wanted to investigate if patients using carisoprodol had increased risk of being involved in a traffic accident. Methods: Data were retrieved from three population-based registries for the period April 2004–September 2005. The Norwegian Prescription Database contained individual information on all dispensed drugs at all pharmacies outside hospitals. The Norwegian Road Accident Registry contained information on all drivers involved in motor vehicle accidents with person injury. The Norwegian Central Population Registry was used to control for emigration or death. The accident incidence among carisoprodol exposed and unexposed subjects was compared by standardized incidence ratio. Results: Having a prescription for carisoprodol dispensed increased the standardized incidence ratio for being involved in an accident with person injury to 3.7 (95% CI 2.9–4.8) the first week after the date of dispensing. This was similar to diazepam (2.8; 2.2–3.6), but higher than for salbutamol (1.1; 0.6–1.8). Conclusions: Patients receiving carisoprodol seem to have an increased risk of being involved in traffic accidents involving person injury. The study gives support to earlier work published on the impairing effects of carisoprodol. [Copyright &y& Elsevier]

Abstract: Objective: To investigate the relationship between pregnancy outcome and injury severity of pregnant woman in traffic accidents. Method: We reviewed insurance reports of traffic accidents and collected data on injuries of pregnant women and outcomes of their pregnancies. Result: A total of 135 pregnant women, with a mean injury severity score of 1.8±4.0, were involved in traffic accidents from 1994 through 2003. Injury severity score, abdominal abbreviated injury scale score were significantly higher in women whose neonates died than in women with healthy newborns. However, neither the likelihood of having been subjected to direct external forces during the accident nor injury severity differed between women with spontaneous abortions and woman with healthy newborns. Conclusion: Predicting abortion on the basis of maternal injury severity is difficult. Because unknown variables may contribute to fetal loss, further studies of traffic injuries are needed. [Copyright &y& Elsevier]

Summary: A traffic injury can be traumatic from both physical and emotional points of view. Nine people injured in a traffic environment were interviewed 6 months after the incident in a qualitative study about their experiences of pre-hospital and hospital care and subsequent rehabilitation. The transcribed data were analysed using qualitative content analysis. Four themes emerged: (i) facing commotion, (ii) experiencing trust and security, (iii) lacking security and support, and (iv) struggling to return to everyday life. The main findings in the study indicate that the quality in the interaction between people injured in traffic events and their care providers are of utmost importance. Interaction must be seen as a dialectic process in which caregivers are open to the injured person’s needs. An open-minded caregiver makes recovery easier for the injured. [Copyright &y& Elsevier]

Abstract: The aim of the study was to investigate social and behavioral correlates of perceived vulnerability to traffic injuries in an urban and rural setting in Tanzania. In 2002, a sample of 494 adults aged 15 years and above participated in household interviews in Dar es Salaam (urban) and Hai District (rural). The study was part of a population-based survey that collected self-report data on non-fatal injuries. In Dar es Salaam 75 and 82% of males and females, respectively, perceived it as likely that they would experience a traffic injury in general. The corresponding figures in Hai were 63 and 64%. Men rated their road traffic vulnerability similarly to women (OR=0.8, 95% CI 0.5–1.3). Factors associated with high perceived vulnerability as a pedestrian or being injured by a bicycle were amount of road safety information received from health workers and friends, having caused a car to swerve and having crossed a road while talking. Respondents perceived driver recklessness and driver drunkenness as the leading causes of traffic injuries in both areas. Differences were found between the urban and rural setting with respect to perceived risk for traffic injury. The implications of these findings in the context of traffic injury prevention are discussed. [Copyright &y& Elsevier]

With improving rates of survival following road traffic injuries in many countries, healthy years of life lost due to crashes increasingly reflect the prevalence of disabling sequelae. This review examines the epidemiological evidence regarding the risk of disability due to car crashes, published between 1980 and 2002. Studies of sequelae limited to specific domains (e.g. head injury, whiplash, psychiatric morbidity) were excluded. Of the 19 studies meeting the criteria for review, most focused on the prevalence of disability following crashes but not the association between them. Prevalence estimates of post-crash disability varied from 2 to 87%. The potential sources of heterogeneity included differences in study settings and period, duration of follow-up, and definitions of exposure and outcome. Methodological problems that compounded the difficulties in interpretation and generalisability of study findings included selection biases and use of non-representative samples, idiosyncratic outcome measures, inadequate adjustment for confounding, and the prevailing medico-legal or compensation context. The findings highlight the need for well-designed population-based epidemiological studies using validated outcome measures and appropriate comparison groups to determine the independent risk of disability due to car crashes. The review also revealed a critical need for data from low- and middle-income countries, the setting for over 90% of the estimated global burden of road traffic injury. [Copyright &y& Elsevier]

Problem: Road traffic injury is the leading cause of death among adolescents in high-income countries. Researchers attribute this threat to driver risk taking, which driver education (DE) attempts to reduce. Many North American authorities grant DE graduates earlier access to unsupervised driving despite no evidence of this being a safety benefit. This theoretical article examines risk taking and DE in relation to an apparent mobility bias (MB) in policymaking. Method: The MB is defined, the history and sources of driver risk taking are examined, and the failure of DE to reduce collision risk is analyzed in relation to a potential MB in licensing policies. Discussion: The author argues that DE''s failure to reduce adolescent collision risk is associated with a MB that has produced insufficient research into DE programs and that influences public policymakers to grant earlier licensure to DE graduates. Recommendations are made regarding future research on DE and risk taking, coordinated improvements to DE and driver licensing, and a plan to reduce collision risk by encouraging parental supervision after adolescent licensure. Impact on Industry: Research on adolescent driver risk taking would have direct applications in DE curricula development, driver''s license evaluation criteria, graduated licensing (GDL) policies, as well as other aspects of human factor research into the crash-risk problem. [Copyright &y& Elsevier]

• After a traffic crash, cyclists and car occupants with injuries demonstrate different recovery trajectories. • Cyclists show greater improvement in pain severity than do car occupants. • Prognostic indicators of long-term physical functioning and psychological well-being for cyclists were pre-injury and baseline quality of life and pain factors and injury location. In this inception cohort study, we investigated differences in health outcomes for bicyclists (cyclists) and car occupants (car driver and passengers) at 12 months after a non-catastrophic traffic injury. We also aimed to determine the independent predictors of key health outcomes among cyclists. Of the 2019 participants at baseline, 299 were cyclists and 927 were car occupants; 229 cyclists and 489 car occupants were followed up 12 months after the injury. A telephone-administered questionnaire was used to obtain information on socio-economic, pre-injury health and injury-related characteristics. The survey also included tools on health outcomes: quality of life (SF-36 and EQ-5D-3L scales), pain severity, general psychological distress, trauma-related distress and pain catastrophizing. After adjusting for all potential confounders, general psychological distress scores and trauma-related distress scores were 2.05 and 0.60 units lower for cyclists than car occupants (P = 0.01 and P < 0.0001, respectively) at 12-month follow-up. Cyclists showed greater improvement than car occupants over 12 months in mean pain severity ratings and SF-12 physical component summary (PCS) score (both P < 0.0001) but had lower mean pain severity and similar PCS scores at baseline. However, cyclists showed less improvement in SF-12 mental component summary (MCS) scores (P = 0.03) than car occupants but had higher mean MCS scores at baseline. Pre-injury and baseline quality-of-life scores and pain catastrophizing as well as injury involving the head or face were significant predictors of overall psychological functioning, general psychological distress and trauma-related distress in cyclists at 12 months. Cyclists demonstrated better recovery than car occupants at 12 months after sustaining a traffic crash injury. Prognostic indicators of long-term physical functioning and psychological well-being in cyclists were related to pre-injury and baseline quality of life and pain factors and injury location. [ABSTRACT FROM AUTHOR]