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This nationwide retrospective cohort study examines the association between adults with hearing loss (HL) and subsequent injury risk. Utilizing data from the Taiwan National Health Insurance Research Database (2000–2017), the study included 19,480 patients with HL and 77,920 matched controls. Over an average follow-up of 9.08 years, 18.30% of the 97,400 subjects sustained subsequent all-cause injuries. The injury incidence was significantly higher in the HL group compared to the control group (24.04% vs. 16.86%, p <.001). After adjusting for demographics and comorbidities, the adjusted hazard ratio (aHR) for injury in the HL cohort was 2.35 (95% CI: 2.22–2.49). Kaplan–Meier analysis showed significant differences in injury-free survival between the HL and control groups (log-rank test, p <.001). The increased risk was consistent across age groups (18–64 and ≥65 years), with the HL group showing a higher risk of unintentional injuries (aHR: 2.62; 95% CI: 2.45–2.80), including falls (aHR: 2.83; 95% CI: 2.52–3.17) and traffic-related injuries (aHR: 2.38; 95% CI: 2.07–2.74). These findings highlight an independent association between HL and increased injury risk, underscoring the need for healthcare providers to counsel adult HL patients on preventive measures. [ABSTRACT FROM AUTHOR]

Background. Road traffic injuries always remain a significant medical and social problem for all mankind, and in Ukraine even during the full-scale invasion of the Russian Federation. The purpose of the study: to determine the clinical and nosological characteristics of victims of road traffic accidents according to the extent of damage in road users. Materials and methods. This article is a continuation of the cycle of publications that were previously published in the journal “Emergency Medicine”, that is, it is a component of a comprehensive study. The actual material of the study were 1,696 cases of road traffic injuries formed by the method of irreversible randomization. The resulting array was formed from victims who were injured in the conditions of a metropolis, a regional city, and a rural area. Results. The conducted analysis found that in the total body of the study, 78.25 % of victims of traffic accidents had damage of up to three anatomical and functional areas (AFAs). Greater damage (4–6 AFAs) occurs in 21.75 % of patients. In the array of those who survived, 79.71 % had damage to 4–6 AFAs, in the array of the dead — 34.68 %. The highest mortality rate is 27.78 % when six AFAs are damaged, and the lowest — with one injured AFA (2.37 %). It was also found that among the “drivers” traffic participants, victims with damage to two (31.56 %) and three AFAs (25.58 %) have the highest specific weight. Among the “passengers” traffic participants, victims with damage to two (33.73 %) and one AFA (26.56 %) have the highest specific weight. Among the “pedestrians” traffic participants, victims with damage to two (29.74 %) and three AFAs (25.15 %) have the highest percentage. Conclusions. 1. It was found that a large amount of damage in general causes a greater threat to the life of a victim of traffic accidents, but the trend is non-linear, that is, the survival is affected by other risk-creating factors. 2. All traffic participants in general have a relatively smaller injury (damage to 1–3 anatomical and functional areas). At the same time, the highest specific weight of such trauma is observed among drivers, and the lowest one among pedestrians. 3. There was a significant influence of the sign of participation in traffic and the extent of damage on the outcome of traumatic process in victims of traffic accidents.

Background/Objectives: Benign paroxysmal positional vertigo (BPPV) is the most common cause of recurrent vertigo and the most common peripheral vestibular disorder. It is characterized by intense vertigo triggered by head and position changes. This study investigates the risk of subsequent injury in BPPV patients and the effects of treatment. Methods: A population-based retrospective cohort study was conducted using data from the Longitudinal Health Insurance Database 2005 in Taiwan. Patients with and without BPPV were identified between 2000 and 2017. The study outcomes were diagnoses of all-cause injuries. The Kaplan–Meier method determined the cumulative incidence rates of injury in both cohorts, and a log-rank test analyzed the differences. Cox proportional hazard models calculated each cohort's 18-year hazard ratios (HRs). Results: We enrolled 50,675 patients with newly diagnosed BPPV and 202,700 matched individuals without BPPV. During follow-up, 47,636 patients were diagnosed with injuries (13,215 from the BPPV cohort and 34,421 from the non-BPPV cohort). The adjusted HR for injury in BPPV patients was 2.63 (95% CI, 2.49–2.88). Subgroup analysis showed an increased incidence of unintentional and intentional injuries in BPPV patients (aHR 2.86; 95% CI, 2.70–3.13 and 1.10; 95% CI, 1.04–1.21, respectively). A positive dose–response relationship was observed with increasing BPPV diagnoses. Treatment with canalith repositioning therapy (CRT) or medications reduced the risk of injury slightly but not significantly (aHR, 0.78; 95% CI, 0.37–1.29, 0.88; 95% CI, 0.40–1.40, respectively). Conclusions: BPPV is independently associated with an increased risk of injuries. CRT or medications have limited effects on mitigating this risk. Physicians should advise BPPV patients to take precautions to prevent injuries even after treatment. [ABSTRACT FROM AUTHOR]

The classical linear regression model allows for a continuous quantitative variable to be modeled simply from other variables. However, this model assumes independence between observations, which, if ignored, can lead to methodological issues. Additionally, not all data follow a normal distribution, prompting the need for alternative modeling methods. In this context, geographically weighted beta regression (GWBR) incorporates spatial dependence into the modeling process and analyzes rates or proportions using the beta distribution. In this study, GWBR was applied to the traffic injury (fatal and non-fatal) crash proportions in Fortaleza, Ceará, Brazil, from 2009 to 2011. The results demonstrated that the local approach using the beta distribution is a viable model for explaining the traffic injury crash proportions, due to its flexibility in handling both symmetric and skewed distributions. Therefore, when analyzing rates or proportions, the use of the GWBR model is recommended. [ABSTRACT FROM AUTHOR]

Background and aims: Quantifying the health burden of alcohol has largely focused upon harm to drinkers, which is an underestimate. There is a growing literature on alcohol's harm to others (HTO), but it lacks the systematic transfer of HTO into a comparative risk assessment framework. This study calculated disability‐adjusted life years (DALYs) for fetal alcohol spectrum disorder (FASD), interpersonal violence and traffic injury due to another's drinking. Design: This study is a disease burden analysis, using modelling of DALYs for New Zealand in 2018. Setting and participants: The study took place among the Aotearoa/New Zealand population in 2018. Measurements The involvement of others' drinking was obtained from prevalence, alcohol‐attributable fraction studies and administrative data. Disability weights (DW) for FASD were adapted from fetal alcohol syndrome (FAS) weights using a Beta–Pert probability distribution; for interpersonal injury, DWs used hospital events linked with injury compensation; for traffic injury, DWs used hospital events. Populations were stratified by ethnicity, age group and gender. A descriptive comparison was made with a previous estimate of DALYs for drinkers. Findings In 2018, 78 277 healthy life years were lost in Aotearoa/New Zealand due to alcohol's HTO. The main contributor (90.3%) was FASD, then traffic crashes (6.3%) and interpersonal violence (3.4%). The indigenous population, Māori, was impacted at a higher rate (DALYs among Māori were 25 per 1000 population; among non‐Māori 15 per 1000 population). The burden of HTO was greater than that to drinkers (DALYs HTO = 78 277; DALYs drinkers = 60 174). Conclusions: Disability from fetal alcohol spectrum disorder (FASD) appears to be a major contributor to alcohol's harm to others in Aotearoa/New Zealand. Taking FASD into account, the health burden of harm to others is larger than harm to the drinker in Aotearoa/New Zealand, and ethnicity differences show inequity in harm to others. Quantification of the burden of harm informs the value of implementing effective alcohol policies and should include the full range of harms. [ABSTRACT FROM AUTHOR]

Objective To analyze the change of disease burden of injury in China from 1990 to 2019, and to predict the change trend from 2020 to 2034, so as to provide basis for the formulation of injury prevention and control strategies. Methods Using the global disease burden research database in 2019, the change trends of age - standardized incidence, prevalence, mortality and disability 一 adjusted life expectancy rate of injuries in China were analyzed, and the average annual change percentage was calculated. The grey prediction model GM (1) was used to predict the annual DALY change trend from 2020 to 2034. Results From 1990 to 2019, the incidence, prevalence, mortality and Daly rate of self 一 injury and interpersonal violence showed a downward trend, with the largest decrease among people aged 0-9 (AAPC = 一 2. 27%, -- 0. 26%, -- 4. 72%, - 6. 00%). The incidence and prevalence of traffic injuries showed an upward trend, while mortality and DALY rates generally showed a downward trend, but those over 70 years old showed an upward trend (AAPC 二 0. 26%, 0. 88%). The incidence of accidental injuries showed an overall downward trend (AAPC = 一 0. 08%), but showed an upward trend in 2006一2019 (AAPC = 2.69%), and the mortality and DALY rates showed an overall downward trend, among which the morbidity, prevalence, mortality and Daly rates of people M 70 years old showed an upward trend (AAPC = 1. 84%, 1. 15%, 0. 66%, 0. 51%). The grey prediction model showed that the DALY of the three kinds of injuries will show a downward trend from 2020 to 2034. It is estimated that by 2035, the Daly rate will decrease to 166. 304 / 100 000, 862. 338 / 100 000 and 715, 27 / 100 000 respectively. Conclusion The mortality rate and DALY rate of three kinds of injuries in China show a general downward trend from 1990 to 2019, but the incidence rate of traffic injuries and accidental injuries are still rising, and the disease burden of the elderly is still increasing. [ABSTRACT FROM AUTHOR]

Limited data are available in Mexico on the prevalence of alcohol and drug use and the possible differences in their effects on types of road traffic injury (RTI), such as those involving pedestrians, drivers or passengers of motorcycles or other motor vehicles, and the association between substance use and driving behaviors, for preventive purposes. The sample comprised 433 adult RTI patients, admitted to the emergency department (ED) of a public hospital in Mexico City (January to April 2022). Breath Alcohol Concentration (BAC) was measured using a breath tester, and six types of drugs (amphetamines, barbiturates, benzodiazepines, cannabis, cocaine, and methamphetamine) were assessed using a saliva screen test. RTI patients also self-reported their alcohol and drug use in the six hours prior to the accident. Approximately 62% of respondents had been involved in a motorcycle crash. One in three patients self-reported or had traces of a substance in their saliva or breath. The most common substance was alcohol (23.6%), followed by cannabis and stimulants (10.9%). One in five patients reported having used a cell phone ten minutes before the injury. One in three had not been using any safety device, the only behavior exacerbated by substance use. We found a high prevalence of substance use in the sample of RTI patients admitted to the ED, regardless of the type of the RTI, together with high cell phone rates. Motorcycle passengers under the influence were particularly likely not to have been wearing a helmet. [ABSTRACT FROM AUTHOR]

Road traffic accidents cause significant trauma to the population and are one of the main causes of mortality in working age. The novelty of the study risk-oriented patterns of severity of damage and mortality of victims of road accidents have been established. The aim - to create of a fundamental basis for the formation of clinical routes and protocols for victims of road accidents by establishing and verification the relationship between the severity of damage and the death of the victims. Material and methods. An analysis of 1,696 cases of road traffic injuries was carried out, and the standardized New Injury Severity Score (NISS) assessment system was used. Results. A probable, but indirect dependence of the clinical effective risk of a negative outcome of the traumatic process in victims on the severity of the damage was established. It was established that the sign of participation in the traffic the formation of clinical effective risks of a negative outcome of the traumatic process, starting with the severity of damage according to the NISS with 25 points. With the same qualitative characteristics, pedestrians have the highest risk of fatality, drivers have the lowest risk. The synergistic effect of the severity of damage and the clinical and anatomical form of the injury was established. Conclusions. The risk of a fatal outcome of a road traffic injury in general directly depends on the severity of damage to the victim, although the dependence is not direct. The clinical and anatomical form of damage together with the severity of the damage have a synergistic effect on the formation of the clinically effective risk of mortality in victims of a road traffic accident, and the predominant influence is the clinical and anatomical form of damage. No conflict of interests was declared by the authors.

Background. The provision of modern medical care to victims of road accidents requires the development of standardized approaches. One of the main mechanisms for solving this problem is the formation of scientifically sound clinical protocols and clinical routes for providing medical care, which is essential to creating a model of traffic injury. The purpose of the study was to form a mo­del of traffic trauma in Ukraine as a health-sanitary consequence of an emergency of a man-made nature as a whole and on its basis — a model of providing medical assistance to victims of traffic trauma. Materials and methods. An array of studies of 1696 victims as a result of a traffic accident was formed. Methods of full mo­deling, insoluble randomization, formal logic, and medical statistics were applied. Clinical effective risks were identified. Results. Fundamental principles of modeling road trauma as a health-sanitary consequence of an emergency of a man-made nature as a whole and according to the main types of administrative-territorial entities of Ukraine were presented. The main criterion was the risk of the most serious consequence-the death of the victim, as well as determining the impact of risk-forming factors that did not form clinical-results risk. It has been proven that modeling traffic injury is an effective mechanism for reducing the severity of the medical consequences of road accidents. Conclusions. It is advisable to carry out the formation of models of traffic injury on a hierarchical principle. The principle of modeling significantly optimized making clinical and organizational decisions in the process of providing medical care and allowed to reduce the mortality rate of the victims by 8–11 %.

Background. Road traffic injury remains a significant medical and social problem for all humanity at any time. The aim of the research: to determine the characteristics of the victims of traffic accidents depending on the sign of their participation in traffic and living conditions. Materials and methods. This article is a continuation of previous publications in the journal “Emergency medicine (Ukraine)”, that is, this component of the comprehensive study was conducted using a single factual material. The actual material of the study is 1,696 cases of traffic injuries, which were selected by the method of irreversible randomization. Model 1 of the real-life type was chosen to be a metropolis with a volume of actual material of 1,139 victims with traffic injuries, model 2 (rural area) — 315 cases, model 3 (regional city) — 242 cases. The study of the actual material was carried out using the methods of parametric and non-parametric statistics, the law of formal logic and fractal analysis. Results. The study found that the properties of the research models have a significant impact on the occurrence of injuries depending on the sign of participation in traffic. The largest specific weight of drivers was recorded in the metropolis (40.65 %), the smallest — in rural areas (16.19 %). The specific weight of passengers was the highest in the regional city (36.36 %), rural areas (23.49 %), and the lowest in the metropolis (22.43 %). The highest specific weight of pedestrians was observed in rural areas (60.32 %), in the metropolis this figure is 36.88 %, and the lowest specific weight is in the regional city (27.28 %). In addition, the influence of the characteristics of the models on the formation of the research array was found depending on the sign of participation in traffic and the victim’s gender. Attention is drawn to the very low share of female drivers (4.55 %) in rural areas, while in a regional city, this figure is 24.39 %. The influence of the properties of the models and signs of participation in traffic on the occurrence of a negative outcome of the traumatic process in the victims of traffic accidents has also been proven. As a result of the analysis, the impact of research models on the emergence and formation of the array of victims with a negative outcome of the traumatic process was determined, depending on their age and participation in the traffic. Conclusions. Probable and direct influence of living conditions and signs of participation in the traffic on the formation of an array of victims of traffic accidents has been found. Gender has a significant impact in all research models, and it is most pronounced in the conditions of a metropolis in male victims. The sign of participation in traffic has a significant effect on the outcome of the traumatic process in victims of traffic accidents. This effect is especially pronounced in those who were injured in rural areas. The highest fatality rate among all road users is observed among pedestrians in rural areas (37.37 %), and the lowest among drivers in metropolitan areas (3.02 %).

Introduction: Trauma is the leading cause of death in the population up to the age of 44 years of age. It is estimated that 14,000 people die every day worldwide as a result of trauma. Road traffic trauma and falls are the direct causes of more than one-third of these deaths. This work aims to demonstrate the role and importance of the Emergency Medical Service [EMS] in caring for patients injured in road traffic accidents. Materials and methods: Retrospective observational research was conducted in the emergency medical services(EMS) of Bečej Health Center [HC Bečej]. Results: During the one year, the EMS of HC Bečej treated 61 patients injured in road traffic accidents. 36 (59.02%) were men and 25 (40.98%) were women. Injuries in treated patients were qualified and classified according to the AIS (Abbreviated Injury Scale) score. Head and neck injuries were present in 32 (52.46%) of the patients with a mean AIS score of 3.26 ± 2.24. Facial injuries were found in 9 (14.76%) patients with AIS 4.4±2.54. Chest injuries were found in 24 (39.34%) patients (AIS 3.57±2.22) and abdominal injuries in 7 (11.48%) patients (AIS 4.92±2.56). More than half of the patients, 36 (59.02%) had extremity injuries (AIS 2.79±2.18) and 36 (47.54%) had superficial body injuries (AIS 3.08±2.29). Two patients died at the scene. The remaining 59 (96.72%) were treated by the EMS team. After treatment, 50 (81.97%) patients were sent to one of the stationary health institutions for further examination, and the remaining 9 (14.75%) were definitively treated at HC Bečej. Conclusion: Most patients sustained extremity and superficial body injuries. However, the most severe injuries were in the abdomen and face.

Background. One of the main causes of death and disability of the population in Ukraine is traffic accidents. In addition, in 2022–2023, the number of fatal traffic accidents increased. The purpose was to determine the peculiarities of the clinical and epidemiological characteristics of traffic injuries as medical and sanitary consequences of emergencies in the components of the totality of the phenomenon (traffic accident). Materials and methods. The actual material of the study was 1,696 cases of traffic injuries, which were selected by the method of irreversible randomization. The study was conducted in 2019–2020. This array was distributed according to the conditions of an epidemiological experiment on natural models, which was formed in accordance with the requirements and criteria of the law of large numbers. Model 1 is a metropolis. This model includes victims who were injured and were treated in a metropolis (population of more than 1,000,000). Model 2 — rural area. This model includes victims who were injured in rural areas and were treated at a central district hospital. Model 3 is a regional city. This model includes victims who were injured in the city (population of 300,000–500,000). Results. As a result of the study, it was found that in all research models there was a significant advantage of injured men over women, but this indicator was the highest in model 2 (rural area) — 79.05 %. Indicators in model 1 (metropolis) and in model 3 (regional city) were practically equivalent to the indicator of the mixed regime (63.65, 66.12 and 66.86 %, respectively). The fact that the specific weight of those who survived prevails over that of the deceased in both gender groups in all research models is also noteworthy. The mortality was highest in men and women who were injured as a result of road accidents in rural areas (34.54 and 31.82 %, respectively), the lowest in men of model 2 (regional city; 3.75 %) and in women of model 1 (metropolis; 3.38 %). Also, the comparative analysis showed that the victims in the age group of 21–30 years rank first in all research models. People of working age (21–50 years old) among the victims of road accidents make up 66.81 % in model 1, 58.10 % in model 2, and 53.69 % in model 3. It was found that in almost all age groups, except for those older than 71 years, the highest mortality was observed in model 2 (rural area). The mortality in all study models was highest in the age group over 71 years: model 1 — 16.41 %, model 2 — 44.44 %, model 3 — 60.00 %. The lowest mortality was in model 1 in the age group of 21–30 years (2.17 %), in model 2 in the age group of 61–70 years (24.14 %), in model 3 in the age group of 21–30 years (7.02 %). Conclusions. The clinical and epidemiological characteristics of traffic injuries have specific features for metropolis, rural area, and regional city, which is a sign of certain differences in the infrastructure of models and the lifestyle of the population. All research models are characterized by the predominance of men, but this is especially pronounced in model 2 (rural area) — 79.05 %. The age factor has a significant influence on the formation of the array of victims in the research models, the largest specific weight in all models belongs to people of working age, which is most pronounced in the metropolis — 77.87 %. Age has a significant impact on the outcome of the traumatic process in all research models and is most pronounced in older age groups. The largest array of victims of working age with a negative course of the traumatic process was in rural areas — 75.70 %. Comparative clinical and epidemiological analysis of road traffic injuries in research models indicate the similarity of characteristics to develo­ping countries.

All over the world, children's injuries receive considerable attention. Road traffic injury is the main cause of child death. The aim of the research. To study and evaluate the clinical and nosological characteristics of traffic injuries in children as a medical and sanitary consequence of an emergency situation. Research materials and methods. This work is a continuation of the previous research [2], and is based on the study and retrospective analysis of 259 cases of children injured as a result of a traffic accident in the Kyiv and Chernivtsi regions in 2018-2019. The array of this study was formed by the method of irreversible randomization from the total array of 1,671 cases of traffic injuries that occurred in urban and rural areas of these regions. This work was carried out within the framework of the Doctoral Thesis «Traffic accidents (clinical-epidemiological, clinical-nosological characteristics, clinical features of the course of the traumatic process, principles of medical care)», approved by the Academic Council of the «Ukrainian Scientific and Practical Center of Emergency Medical Aid and Disaster Medicine» of the Ministry of Health of Ukraine (Minutes of the meeting of the Scientific Council No. 6, December 15, 2020), in accordance with the provisions of the Declaration of Helsinki and approved by the Bioethics Commission of the «Ukrainian Scientific and Practical Center of Emergency Medical Aid and Disaster Medicine» of the Ministry of Health of Ukraine (Protocol No. 10, December 8, 2020). Research Results. As a result of the research it was established that in the total number of children with road traffic injuries, the largest specific weight have children with the extent of damage to two anatomical and functional areas (AFA) - 47.67 %, and the smallest specific weight - four AFA (13.95 %). In 84.88 % of traffic injuries in children, they are polysystemic, i. e. two or more AFA are damaged, in the mass of the dead, the specific weight of such an injury is 90.91 %. The highest mortality rate was observed in children with damage to three AFAs (15.00 %), with damage to one AFA the mortality rate was 7.69 %, with damage to two AFAs - 14.63 %, with damage to four AFAs - 8.33 %. In the total number of injured children, the most frequent injury is to the head (82.56 %), and the least frequent is damage to the abdomen and pelvis with a specific gravity of 13.95 %. Limb injuries (56.98 %), chest injuries (41.86 %) and spine injuries (16.28 %) are also quite common in children. The combination factor in the general field is 2.26, in the field of the dead - 2.46 and in the field of the survivors - 2.23. The highest mortality is observed in victims with abdominal and pelvic trauma (25.0 % each), which is almost twice as high as the mortality in the general population (12.79 %). In second place is the mortality rate of children with chest trauma - 19.44 %, with head trauma - 16.90 %, with spinal trauma - 7.14 %. The lowest mortality rate was recorded for children with limb injuries - 4.08 %. Conclusions. 1. Traffic injuries in children in 84.88 % of cases are multicomponent, the combination ratio in the total mass is 2.26. 2. Head (82.56 %), limbs (56.98 %) and chest (41.86 %) are most often injured in traffic accidents. 3. The highest mortality rate is observed in children with pelvic and abdominal trauma (25.0 % each). [ABSTRACT FROM AUTHOR]

Background. The provision of modern medical care to victims of road accidents requires the development of standardized approaches. One of the main mechanisms for solving this problem is the formation of scientifically sound clinical protocols and clinical routes for providing medical care, which is essential to creating a model of traffic injury. The purpose of the study was to form a model of traffic trauma in Ukraine as a health-sanitary consequence of an emergency of a man-made nature as a whole and on its basis - a model of providing medical assistance to victims of traffic trauma. Materials and methods. An array of studies of 1696 victims as a result of a traffic accident was formed. Methods of full modeling, insoluble randomization, formal logic, and medical statistics were applied. Clinical effective risks were identified. Results. Fundamental principles of modeling road trauma as a health-sanitary consequence of an emergency of a man-made nature as a whole and according to the main types of administrative-territorial entities of Ukraine were presented. The main criterion was the risk of the most serious consequence-the death of the victim, as well as determining the impact of risk-forming factors that did not form clinical-results risk. It has been proven that modeling traffic injury is an effective mechanism for reducing the severity of the medical consequences of road accidents. Conclusions. It is advisable to carry out the formation of models of traffic injury on a hierarchical principle. The principle of modeling significantly optimized making clinical and organizational decisions in the process of providing medical care and allowed to reduce the mortality rate of the victims by 8-11 %. [ABSTRACT FROM AUTHOR]

Objective: The use of motorcycles in commercial transportation is increasing due to its comfortable use in congested traffic conditions and the ease of parking on narrow streets. Motorcycle couriers are among the important members of the delivery industry. The race against time and delivering on time bring along many problems. This study aims to examine the relationships between perceived organizational support, colleague value and stress in motor courier employees. Method: Within the scope of the study, 151 motorcycle couriers working in the delivery sector were selected. The study was carried out in the period of June-November 2022. In addition to 15 questions including demographic characteristics with the one-to-one interview method, Spielberger's State and Trait Anxiety Scale, The Perceived Organizational Support Scale and The Coworker Support Scale were applied with the one-to-one interview method. Results: The average age of the 151 couriers included in the study was 29.10±7.01; the working year was 3.26±3.39; the average number of daily trips was 36.47±17.37; the average delivery time was 16.54±10.10 in minutes (median 15); and the average weight of the cargo was 4.94±5.51 (kg) (median: 3.50). The prevalence of occupational accidents in the last year has been 43.3% (n=61). Examining the causes of the prevalence of accident among the study population, it was found that motorcycle overturning was 20 (32.8%); vehicle hitting the motorcycle was 26 (42.6%); motorcycle hitting the vehicle was 15 (24.6%). When the factors affecting the perceived organizational support were examined, it was found that those with a colleague social support score above 18 were more likely to have an organizational perception score above 80 (95% CI 1.001-4.843) with a rate of [OR]=2.20 times higher, and those with a status anxiety score above 40 were more likely to have an organizational perception score over 80 with a rate of [OR]=2.49 times higher (95% CI: 1.156-5.364). In addition, it was seen that the probability of having an organizational perception score above 80 was [OR]=0.42 times higher (95%CI: 0.200-0.889) in participants who had a work accident. Conclusions: The intense pace of work and the pressure of fast delivery increase couriers' state and trait concerns. Developing policies to improve the psychosocial working environment for a more decent and healthier working environment that improves the mental health and well-being of couriers is recommended. Commercial food ordering platforms must treat driver safety as important when determining delivery times. [ABSTRACT FROM AUTHOR]

Background. Road traffic injury remains one of the most serious and complex types of human injury both in Ukraine and around the world. The purpose of the research: to determine the location and extent of spinal cord injuries as a component of polytrauma as a result of a road accident. Materials and methods. We formed a study array of 298 victims with spinal cord injuries from the array of road accident victims (1,696 people) who were treated in the emergency medical care hospital of the city of Kyiv, the emergency medical care hospital of the city of Chernivtsi, and three central district hospitals of the Kyiv region in 2020–2021. Formation of the research array was carried out by the method of irreversible randomization using the technology of random numbers. The selection criterion for inclusion in the study was the presence of spinal cord injury in road accident victims. At the same time, verification of the nature of the damage was determined at this stage of the study only by clinical and anatomical features, namely, the cervical spine, the thoracic spine and the lumbar spine. Results. It was established that 87.25 % receive damage to one part of the spine. Damage to all parts of the spine in road accidents occurs in 1.68 %. Among the combination of injuries of the spine, the combination of injuries of the thoracic and lumbar parts has the largest specific weight. Spinal cord injury occurs most often in drivers 37.05 %, the least common in pedestrians 30.82 %. According to the NISS, 51.02 % of victims receive a mild spinal cord injury, 39.99 % of victims receive a severe spinal cord injury. In victims with a severity of 25 points, damage to the cervical spine has the largest specific weight of 40.29 %, the smallest is the thoracic section of 28.70 %. In drivers and passengers, the cervical spine is most often damaged, 53.85 and 48.91 %, respectively. In pedestrians, the lumbar spine is most often injured, 47.19 %. The coefficient of combination of damage to several sections of the spine at the same time for drivers and passengers is 1.14, and for pedestrians — 1.6. Conclusions. Spine injuries occur in 17.98 % of victims of traffic accidents. Most often, the cervical spine is damaged in 46.64 %, thoracic — in 32.55 %, and lumbar — in 35.23 % of those injured as a result of traffic accidents.

One of the main causes of death among children is road traffic injuries. In Ukraine, such a problem is quite acute due to infrastructural and socio-economic factors, and with the beginning of the full-scale invasion of the Russian Federation into the sovereign territory of Ukraine, this problem has become even more acute. The aim of the study is to determine and evaluate the clinical and epidemiological characteristics of traffic injuries among children as a medical and sanitary consequence of an emergency situation. Materials and methods. The study is based on the study and retrospective analysis of 259 cases of road traffic injuries in children, which formed the body of the study. The formation of the array was carried out by the method of irreversible randomization from 1,671 victims of road traffic accidents who received road traffic injuries in rural and urban areas in 2018-2019. Randomization was carried out according to the age of the child from 0 to 18 years. The specific gravity of children's road traffic injuries was 15.50 % of the total number of road traffic accident victims. The scope of the research exceeds what is necessary and sufficient according to the law of large numbers. The methods of analysis were parametric, non-parametric methods of statistical analysis, fractal analysis, laws of formal logic. The analysis was carried out using computer technologies in the system Statistica. The study was conducted within the framework of the Doctoral Thesis «Road Traffic Accident (Clinical- Epidemiological, Clinical- Nosological Characteristics, Clinical Features of the Course of the Traumatic Process, Principles of Medical Care)», approved by the Academic Council of the «Ukrainian Scientific and Practical Center of Emergency Medical Aid and Disaster Medicine of the Ministry of Health of Ukraine» (Protocol of the Meeting of the Scientific Council No. 6, December 2020). of Emergency Medical Aid and Disaster Medicine of the Ministry of Health of Ukraine» (Minutes of the meeting of the Scientific Council No. 6 dated December 15, 2020) in accordance with the provisions of the Declaration of Helsinki and approved by the Bioethics Commission of the «Ukrainian Scientific and Practical Center of Emergency Medical Aid and Disaster Medicine of the Ministry of Health of Ukraine» (Minutes No. 10 dated December 8, 2020). Research results. As a result of the study, it was determined that the majority of the population is male (boys) - 52.33 %. Girls make up 47.67 %. This is 12.79 % of the total mass. In the mass of those who died, boys predominate by specific weight - 81.82 %, and in the mass of those who survived, girls predominate (52.00 %). The mortality rate for boys is 20.00 %, and for girls - 4.88 %, i. e. the risk of dying in a traffic accident is 4 times higher for boys than for girls. In the total body of research by age, children aged 6-18 years (school period) have the highest specific weight - 89.19 %, in second place - children aged 3-6 years (preschool period), 9.27 %, and the lowest specific we ight - children aged 0-3 years (1.54 %). The highest mortality was recorded in the age group 0-3 years - 25.00 %, the lowest - in the age group 3-6 years, 12.50 %. According to the sign of participation in traffic in the total array, the largest specific weight of injured children falls on passengers of four-wheeled vehicles - 46.51 %, in second place - children- pedestrians with an indicator of 37.21 %, drivers and passengers of two-wheeled vehicles have the lowest specific weight - 16.28 %. Pedestrians account for more than half of the mass of the dead - 54.55 %. The fatality rate among drivers and passengers of two-wheeled vehicles is 7.14 %, among passengers of four-wheeled vehicles - 10.00 %, and the highest - among pedestrians - 18.75 %. Conclusions. Road traffic injuries in children have certain clinical and epidemiological characteristics, which consist in gender and age characteristics and participation in traffic. In the range of victims, boys predominate - 52.33 %, at the same time, a significant influence of sex on the outcome of the traumatic process has been established, and girls have a greater chance of survival. Age has a significant influence on both the occurrence of road traffic injury and the outcome of the traumatic process. Children aged 6-18 years have the highest specific weight among the injured - 89.19 %. The highest mortality is observed in the age group of 0-3 years - 25.00 %. Participation of children in road traffic has a strong influence both on the formation of the number of victims and on the outcome of the traumatic process. The largest specific weight has four-wheeled vehicle passengers - 46.51 % and pedestrians - 37.21 %. The highest mortality rate is observed among pedestrians - 18.75 %. [ABSTRACT FROM AUTHOR]

Abstract Background The knowledge about the long-term consequences in terms of sickness absence (SA) among pedestrians injured in a traffic-related accident, including falls, is scarce. Therefore, the aim was to explore diagnosis-specific patterns of SA during a four-year period and their association with different sociodemographic and occupational factors among all individuals of working ages who were injured as a pedestrian. Methods A nationwide register-based study, including all individuals aged 20–59 and living in Sweden, who in 2014–2016 had in- or specialized outpatient healthcare after a new traffic-related accident as a pedestrian. Diagnosis-specific SA (> 14 days) was assessed weekly from one year before the accident up until three years after the accident. Sequence analysis was used to identify patterns (sequences) of SA, and cluster analysis to form clusters of individuals with similar sequences. Odds ratios (ORs) with 95% confidence intervals (CIs) for association of the different factors and cluster memberships were estimated by multinomial logistic regression. Results In total, 11,432 pedestrians received healthcare due to a traffic-related accident. Eight clusters of SA patterns were identified. The largest cluster was characterized by no SA, three clusters had different SA patterns due to injury diagnoses (immediate, episodic, and later). One cluster had SA both due to injury and other diagnoses. Two clusters had SA due to other diagnoses (short-term and long-term) and one cluster mainly consisted of individuals with disability pension (DP). Compared to the cluster “No SA”, all other clusters were associated with older age, no university education, having been hospitalized, and working in health and social care. The clusters “Immediate SA”, “Episodic SA” and “Both SA due to injury and other diagnoses” were also associated with higher odds of pedestrians who sustained a fracture. Conclusions This nationwide study of the working-aged pedestrians observed diverging patterns of SA after their accident. The largest cluster of pedestrians had no SA, and the other seven clusters had different patterns of SA in terms of diagnosis (injury and other diagnoses) and timing of SA. Differences were found between all clusters regarding sociodemographic and occupational factors. This information can contribute to the understanding of long-term consequences of road traffic accidents.

Aims: To measure the impact of Canada's recreational cannabis legalization (RCL) in October 2018 and the subsequent impact of the coronavirus disease 2019 (COVID‐19) lockdowns from March 2020 on rates of emergency department (ED) visits and hospitalizations for traffic injury. Design: An interrupted time series analysis of rates of ED visits and hospitalizations in Canada recorded in population‐based databases from January/April 2010 to March 2021. Setting: ED visits in Ontario and Alberta and hospitalizations in Ontario, Alberta, British Columbia, the Prairies (Manitoba and Saskatchewan) and the Maritimes (Nova Scotia, New Brunswick, Newfoundland and Prince Edward Island). Participants: Monthly counts of presentations to the ED or hospital for motor vehicle injury or pedestrian/cyclist injury, used to calculate monthly rates per 100 000 population. Measurements An occurrence of one or more International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Canada (ICD‐10‐CA) code for motor vehicle injury (V20–V29, V40–V79, V30–V39 and V86) and pedestrian/cyclist injury (V01–V09 and V10–V19) within the National Ambulatory Care Reporting System and Discharge Abstract Database. Findings There were no statistically significant changes in rates of ED visits and hospitalizations for motor vehicle or pedestrian/cyclist injury after RCL after accounting for multiple testing. After COVID‐19, there was an immediate decrease in the rate of ED visits for motor vehicle injury that was statistically significant only in Ontario (level change β = −16.07 in Ontario, 95% CI = −20.55 to −11.60, P = 0.000; β = −10.34 in Alberta, 95% CI = −17.80 to −2.89, P = 0.008; α of 0.004) and no changes in rates of hospitalizations. Conclusions: Canada's recreational cannabis legalization did not notably impact motor vehicle and pedestrian/cyclist injury. The rate of emergency department visits for motor vehicle injury decreased immediately after COVID‐19 lockdowns, resulting in rates below post‐recreational cannabis legalization levels in the year after COVID‐19. [ABSTRACT FROM AUTHOR]

Background. Road traffic injury remains one of the most serious and complex types of human injury both in Ukraine and around the world. The purpose of the research: to determine the location and extent of spinal cord injuries as a component of polytrauma as a result of a road accident. Materials and methods. We formed a study array of 298 victims with spinal cord injuries from the array of road accident victims (1,696 people) who were treated in the emergency medical care hospital of the city of Kyiv, the emergency medical care hospital of the city of Chernivtsi, and three central district hospitals of the Kyiv region in 2020–2021. Formation of the research array was carried out by the method of irreversible randomization using the technology of random numbers. The selection criterion for inclusion in the study was the presence of spinal cord injury in road accident victims. At the same time, verification of the nature of the damage was determined at this stage of the study only by clinical and anatomical features, namely, the cervical spine, the thoracic spine and the lumbar spine. Results. It was established that 87.25 % receive damage to one part of the spine. Damage to all parts of the spine in road accidents occurs in 1.68 %. Among the combination of injuries of the spine, the combination of injuries of the thoracic and lumbar parts has the largest specific weight. Spinal cord injury occurs most often in drivers 37.05 %, the least common in pedestrians 30.82 %. According to the NISS, 51.02 % of victims receive a mild spinal cord injury, 39.99 % of victims receive a severe spinal cord injury. In victims with a severity of 25 points, damage to the cervical spine has the largest specific weight of 40.29 %, the smallest is the thoracic section of 28.70 %. In drivers and passengers, the cervical spine is most often damaged, 53.85 and 48.91 %, respectively. In pedestrians, the lumbar spine is most often injured, 47.19 %. The coefficient of combination of damage to several sections of the spine at the same time for drivers and passengers is 1.14, and for pedestrians — 1.6. Conclusions. Spine injuries occur in 17.98 % of victims of traffic accidents. Most often, the cervical spine is damaged in 46.64 %, thoracic — in 32.55 %, and lumbar — in 35.23 % of those injured as a result of traffic accidents. [ABSTRACT FROM AUTHOR]

This study utilised multi-year data from 5354 incidents to predict pedestrian–road traffic accidents (PTAs) based on twelve socioeconomic and built-environment factors. The research employed the logistic regression model (LRM) and the fuzzy-analytical hierarchy process (FAHP) techniques to evaluate and assign weights to each factor. The susceptibility map for PTAs is generated using the "Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS)". Subsequently, the probability of accidents in 2020 was predicted using real multi-year accident data and the Markov chain (MC) and cellular automata Markov chain (CA-MC) models, with the prediction accuracy assessed using the Kappa index. Building upon promising results, the model was extrapolated to forecast the probability of accidents in 2023. The findings of the LRM demonstrated the significance of the selected variables as predictors of accident likelihood. The prediction approaches identified areas prone to high-risk accidents. Additionally, the Kappa for no information (KNO) statistical value was calculated for both the MC and CA-MC models, which yielded values of 0.94 and 0.88, respectively, signifying a high level of accuracy. The proposed methodology is generalizable, and the identification of high-risk locations can aid urban planners in devising appropriate preventive measures. [ABSTRACT FROM AUTHOR]

The classical linear regression model allows for a continuous quantitative variable to be modeled simply from other variables. However, this model assumes independence between observations, which, if ignored, can lead to methodological issues. Additionally, not all data follow a normal distribution, prompting the need for alternative modeling methods. In this context, geographically weighted beta regression (GWBR) incorporates spatial dependence into the modeling process and analyzes rates or proportions using the beta distribution. In this study, GWBR was applied to the traffic injury (fatal and non-fatal) crash proportions in Fortaleza, Ceará, Brazil, from 2009 to 2011. The results demonstrated that the local approach using the beta distribution is a viable model for explaining the traffic injury crash proportions, due to its flexibility in handling both symmetric and skewed distributions. Therefore, when analyzing rates or proportions, the use of the GWBR model is recommended.

• 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]

Background: The knowledge about the long-term consequences in terms of sickness absence (SA) among pedestrians injured in a traffic-related accident, including falls, is scarce. Therefore, the aim was to explore diagnosis-specific patterns of SA during a four-year period and their association with different sociodemographic and occupational factors among all individuals of working ages who were injured as a pedestrian. Methods: A nationwide register-based study, including all individuals aged 20–59 and living in Sweden, who in 2014–2016 had in- or specialized outpatient healthcare after a new traffic-related accident as a pedestrian. Diagnosis-specific SA (> 14 days) was assessed weekly from one year before the accident up until three years after the accident. Sequence analysis was used to identify patterns (sequences) of SA, and cluster analysis to form clusters of individuals with similar sequences. Odds ratios (ORs) with 95% confidence intervals (CIs) for association of the different factors and cluster memberships were estimated by multinomial logistic regression. Results: In total, 11,432 pedestrians received healthcare due to a traffic-related accident. Eight clusters of SA patterns were identified. The largest cluster was characterized by no SA, three clusters had different SA patterns due to injury diagnoses (immediate, episodic, and later). One cluster had SA both due to injury and other diagnoses. Two clusters had SA due to other diagnoses (short-term and long-term) and one cluster mainly consisted of individuals with disability pension (DP). Compared to the cluster "No SA", all other clusters were associated with older age, no university education, having been hospitalized, and working in health and social care. The clusters "Immediate SA", "Episodic SA" and "Both SA due to injury and other diagnoses" were also associated with higher odds of pedestrians who sustained a fracture. Conclusions: This nationwide study of the working-aged pedestrians observed diverging patterns of SA after their accident. The largest cluster of pedestrians had no SA, and the other seven clusters had different patterns of SA in terms of diagnosis (injury and other diagnoses) and timing of SA. Differences were found between all clusters regarding sociodemographic and occupational factors. This information can contribute to the understanding of long-term consequences of road traffic accidents. [ABSTRACT FROM AUTHOR]

Objective: Although driving-related policies aimed at mitigating drug-related motor vehicle crashes (MVCs) have been implemented in diverse communities, data regarding their effectiveness are largely absent. A comprehensive evaluation of these policies is necessary. Furthermore, as US states legalize the recreational use of cannabis, the impact of these policies on drug-related crashes also needs to be evaluated. The objective was to assess the association between drug use prevalence among individuals (age 16+) injured in non-fatal MVCs in 2023 and various related policies, including drug-impaired driving policies, sobriety checkpoints, enforcement programs, and state cannabis legalization status., Methods: We analyzed 2023 emergency medical services (EMS) records of individuals (age 16+) injured in non-fatal MVCs across 19  US states where EMS personnel indicated drug use, excluding duplicate, incomplete, and alcohol-only records. Using these counts, we calculated the prevalence of drug use among individuals (age 16+) injured in non-fatal MVCs in each state. The association between drug use prevalence and state-level policies, including drug-impaired driving laws (i.e., per se or zero tolerance), sobriety checkpoints, enforcement programs, and cannabis legalization laws, was evaluated using adjusted Poisson regression with random effects for state differences. Policies were assessed individually and in a full model to evaluate their individual and additive effects., Results: In 2023, 11,538 individuals (68.2% male) were injured in drug-related non-fatal crashes. Neither drug-impaired driving policies, the use of sobriety checkpoints, nor the implementation of State Judicial Outreach Liaisons influenced the prevalence of drug use among individuals injured in non-fatal crashes. In contrast, relative to states with no policy or cannabidiol/low tetrahydrocannabinol, those permitting recreational cannabis had significantly higher prevalence (adjusted prevalence ratio [aPR]: 1.57, 95% confidence interval [CI]: 1.22, 2.02). The implementation of sobriety checkpoints was associated with higher drug use prevalence (aPR: 1.59, 95% CI: 1.22, 2.09) when drug-impaired driving policies were absent, particularly in states permitting recreational cannabis., Conclusion: Our findings show differences in drug use prevalence among individuals (age 16+) injured in non-fatal MVCs based on state-level policies, highlighting the need for holistic enforcement strategies to address drug-related crashes, especially amid the increasing risks associated with the legalization of recreational cannabis use.

Abstract Background Trauma is a major cause of death worldwide, especially in Low and Middle-Income Countries (LMIC). The increase in health care costs and the differences in the quality of provided services indicates the need for trauma care evaluation. This study was done to develop and use a performance assessment model for in-hospital trauma care focusing on traffic injures. Methods This multi-method study was conducted in three main phases of determining indicators, model development, and model application. Trauma care performance indicators were extracted through literature review and confirmed using a two-round Delphi survey and experts’ perspectives. Two focus group discussions and 16 semi-structured interviews were conducted to design the prototype. In the next step, components and the final form of the model were confirmed following pre-determined factors, including importance and necessity, simplicity, clarity, and relevance. Finally, the model was tested by applying it in a trauma center. Results A total of 50 trauma care indicators were approved after reviewing the literature and obtaining the experts’ views. The final model consisted of six components of assessment level, teams, methods, scheduling, frequency, and data source. The model application revealed problems of a selected trauma center in terms of information recording, patient deposition, some clinical services, waiting time for deposit, recording medical errors and complications, patient follow-up, and patient satisfaction. Conclusion Performance assessment with an appropriate model can identify deficiencies and failures of services provided in trauma centers. Understanding the current situation is one of the main requirements for designing any quality improvement programs.

Abstract Background The knowledge is scarce about sickness absence (SA) and disability pension (DP) among pedestrians injured in a traffic-related accident, including falls. Thus, the aim was to explore the frequencies of types of accidents and injuries and their association with SA and DP among working-aged individuals. Methods A nationwide register-based study, including all individuals aged 16-64 and living in Sweden, who in 2010 had in- or specialized outpatient healthcare after a new traffic-related accident as a pedestrian. Information on age, sex, sociodemographics, SA, DP, type of accident, injury type, and injured body region was used. Frequencies of pedestrians with no SA or DP, with ongoing SA or full-time DP already at the time of the accident, and with a new SA spell >14 days in connection to the accident were analyzed. Crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for new SA were estimated by logistic regression. Results In total, 5576 pedestrians received healthcare due to a traffic-related accident (of which 75% were falls, with half of the falls related to snow and ice). At the time of the accident, 7.5% were already on SA and 10.8% on full-time DP, while 20% started a new SA spell. The most common types of injuries were fractures (45%) and external injuries (30%). The body region most frequently injured was the lower leg, ankle, foot, and other (in total 26%). Older individuals had a higher OR for new SA compared with younger (OR 1.91; 95% CI 1.44-2.53, for ages: 45-54 vs. 25-34). The injury type with the highest OR for new SA, compared with the reference group external injuries, was fractures (9.58; 7.39-12.43). The injured body region with the highest OR for new SA, compared with the reference group head, face, and neck, was lower leg, ankle, foot, and other (4.52; 2.78-7.36). Conclusions In this explorative nationwide study of the working-aged pedestrians injured in traffic-related accidents including falls, one fifth started a new SA spell >14 days. Fractures, internal injuries, collisions with motor vehicle, and falls related to snow and ice had the strongest associations with new SA.

Equal access to safe transport is increasingly conceptualised as a fundamental right for women, with demonstrated impact on health outcomes, social and economic mobility, and societal participation. This study analysed qualitative and quantitative data to examine travel patterns and experiences among 200 women (aged between 18-64 years) using paid transport for work or educational purposes in Bangladesh. Results showed that the women faced multiple threats to their safety, including gender-based violence, harassment and crime, and traffic and non-traffic injury and that the use of paid transport was associated with high levels of anxiety and fear. Despite these circumstances, the women were captive travellers, forced to make transport choices based on price, availability, and ease of travel rather than safety. Unable to choose safe transports, the women attempted to mitigate risks by changing their travel pattern and behaviour, and by restricted their travel frequency. These findings are discussed within the context of women’s rights and mobility justice.

In South Korea, car insurance that includes medical coverage of traditional Korean medicine (TKM) has increased exponentially. Clinical practice guidelines (CPG) for traffic injuries were established in 2016. We aimed to revise and update de novo CPG and distribute the adapted CPG to TKM practitioners and patients. Clinical key questions from previous CPG were identified and updated regarding the grade of recommendation and level of evidence using additional evidence from the literature obtained through a systematic search and the use of the Grading of Recommendations Assessment, Development, and Evaluation methodology. The dissemination and implementation of the updated CPG were conducted at the CPG Center of Korean Medicine. Ultimately, 25 recommendations based on 13 clinical key questions were developed: 2 for diagnosis, 22 for TKM treatments, and 1 for prognosis. After recognition by professional societies and certification by the CPG Center of Korean Medicine, leaflets, card news, and infographics for TKM doctors in South Korea were produced and distributed. These are the only TKM CPG for patients who have experienced traffic injuries. They are expected to contribute to standardized and evidence-based treatment using TKM and similar interventions. Moreover, disseminating the adapted CPG will promote treatment reliability and strengthen insurance coverage. [ABSTRACT FROM AUTHOR]

This study aims to describe patterns of injury mechanism among patients treated at a tertiary trauma center in Mumbai to identify opportunities for targeted injury prevention strategies. Data were collected from an institutional trauma registry, and all patients presenting with life- or limb-threatening injuries over a 16- month period were included. Univariate and bivariate analyses were performed for demographic characteristics, injury mechanisms, and clinical outcomes. A total of 1,115 patients were treated during the study period, and the in-hospital mortality rate was 32% in this severely injured cohort. More than one half of patients were suffered transportation injuries (58%). Of victims of transportation injuries, 45% were victims of railway injuries and 28% were pedestrians struck by motor vehicles. Mortality was highest among victims of railway injuries (42%) and pedestrians struck by automobiles (38%). Although injury prevention is a major public health concern worldwide, it is important to understand local patterns of injury to guide targeted prevention strategies. This study highlights the utility of trauma registries in collecting crucial injury surveillance data. In this context, a focus on pedestrian safety and railway injury prevention is warranted.

Abstract Background Traffic injuries place a significant burden on mortality, morbidity and health services worldwide. Qualitative factors are important determinants of health but they are often ignored in the study of injury and corresponding development of prehospital Emergency Medical Services (EMS), especially in developing country settings. Here we report our research on sociocultural factors shaping pathways to hospital care for those injured on the roads and streets of Vietnam. Methods Qualitative fieldwork on pathways to emergency care of traffic injury was carried out from March to August 2016 in four hospitals in Vietnam, two in Ho Chi Minh City and two in Hanoi. Forty-eight traffic injured patients and their families were interviewed at length using a semi-structured topic guide regarding their journey to the hospital, help received, personal beliefs and other matters that they thought important. Transcribed interviews were analysed thematically guided by the three-delay model of emergency care. Results Seeking care was the first delay and reflected concerns over money and possessions. The family was central for transporting and caring for the patient but their late arrival prolonged time spent at the scene. Reaching care was the second delay and detours to inappropriate primary care services had postponed the eventual trip to the hospital. Ambulance services were misunderstood and believed to be suboptimal, making taxis the preferred form of transport. Receiving care at the hospital was the third delay and both patients and families distrusted service quality. Request to transfer to other hospitals often created more conflict. Overall, sociocultural beliefs of groups of people were very influential. Conclusions Analysis using the three-delay model for road traffic injury in Vietnam has revealed important barriers to emergency care. Hospital care needs to improve to enhance patient experiences and trust. Socioculture affects each of the three delays and needs to inform thinking of future developments of the EMS system, especially for countries with limited resources.

Abstract Background Bicyclists are the road user group with the highest number of severe injuries in the EU, yet little is known about sickness absence (SA) and disability pension (DP) following such injuries. Aims To explore long-term patterns of SA and DP among injured bicyclists, and to identify characteristics associated with the specific patterns. Methods A longitudinal register-based study was conducted, including all 6353 individuals aged 18–59 years and living in Sweden in 2009, who in 2010 had incident in-patient or specialized out-patient healthcare after a bicycle crash. Information about sociodemographic factors, the injury, SA (SA spells > 14 days), and DP was obtained from nationwide registers. Weekly SA/DP states over 1 year before through 3 years after the crash date were used in sequence and cluster analyses. Multinomial logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for factors associated with each identified sequence cluster. Results Seven clusters were identified: “No SA or DP” (58.2% of the cohort), “Low SA or DP” (7.4%), “Immediate SA” (20.3%), “Episodic SA” (5.9%), “Long-term SA” (1.7%), “Ongoing part-time DP” (1.7%), and “Ongoing full-time DP” (4.8%). Compared to the cluster “No SA or DP”, all other clusters had higher ORs for women, and higher age. All clusters but “Low SA and DP” had higher ORs for inpatient healthcare. The cluster “Immediate SA” had a higher OR for: fractures (OR 4.3; CI 3.5–5.2), dislocation (2.8; 2.0–3.9), sprains and strains (2.0; 1.5–2.7), and internal injuries (3.0; 1.3–6.7) compared with external injuries. The cluster “Episodic SA” had higher ORs for: traumatic brain injury, not concussion (4.2; 1.1–16.1), spine and back (4.5; 2.2–9.5), torso (2.5; 1.4–4.3), upper extremities (2.9; 1.9–4.5), and lower extremities (3.5; 2.2–5.5) compared with injuries to the head, face, and neck (not traumatic brain injuries). The cluster “Long-term SA” had higher ORs for collisions with motor vehicles (1.9;1.1–3.2) and traumatic brain injury, not concussion (18.4;2.2–155.2). Conclusion Sequence analysis enabled exploration of the large heterogeneity of SA and DP following a bicycle crash. More knowledge is needed on how to prevent bicycle crashes and especially those crashes/injuries leading to long-term consequences.

Background: To model, the predictors of injuries caused the hospitalization of motorcyclists using a hybrid structural equation modeling-artificial neural network (SEM-ANN) considering a conceptual model. Methods: In this case-control study, 300 cases and 156 controls were enrolled using a cluster random sampling. The cases were selected among injured motorcyclists in refereed to Imam Reza Hospital and Tabriz Shohada Hospital, Tabriz, Iran since Mar 2013. The predictability of injury by motorcycle-riding behavior questionnaire (MRBQ), Attention-deficit/hyperactivity disorder (ADHD) along with its subscales and motorcycle related variables was modeled using SEM-ANN. By SEM, linear direct and indirect relationships were assessed. To improve the SEM, the ANN was utilized sequentially to account for the nonlinear and interaction effects that is not supported by SEM. Results: The predictors of injury were: MRBQ, ADHD, and its subscales, marital status, education level, riding for fun, engine volume, hyper active child, dark hour riding, cell phone answering, driving license (All P less than 0.05). In addition, the findings reveal the Mediating role of MRBQ for the relationship between underlying predictors and injury. Furthermore, ANN showed higher specificity (95.45 vs.77.88) and accuracy (90.76 vs.79.94) than usual SEM which lead us to introduce the second and third order effect of MRBQ into the modified SEM. Conclusion: The hybrid model provided results that are more accurate; considering the results of the modeling, having intervention programs on ADHD motorcyclists, those have the hyperactive child, and those who answer their cell phones while driving, and improving the motorcyclists’ goal is highly recommended.

Objective: 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. Method: 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. Results: 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. Conclusion: 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.

Objective: To examine the prevalence of drug use among individuals (age 16+) injured in non-fatal motor vehicle crashes (MVCs) from 2019 to 2023 and assess regional differences based on US Census regions (i.e., West, Midwest, Northeast, and South), and thereby contribute to a comprehensive understanding of drug-related MVCs., Methods: We examined emergency medical services data from 19 US states (January 2019 to December 2023) to determine the annual mean drug use prevalence among individuals (age 16+) injured in non-fatal MVCs. Differences in drug use prevalence were assessed using ANOVA with the Tukey-Kramer test for year-to-year comparisons. Adjusted Poisson regression models with random effect for states were used to compare trends to the baseline (i.e., 2019) and to assess regional differences., Results: Among individuals (age 16+) injured in non-fatal MVCs, 62,310 had reported drug use. ANOVA results showed significant year-to-year differences in the prevalence of drug use among individuals injured in non-fatal MVCs, with an increase from 2019 to 2020 and a subsequent decrease from 2020 to 2023 ( p  < 0.05). Compared to the baseline year of 2019, the prevalence in 2020 was 1.34 times (95% confidence interval [CI]: 1.12, 1.61) the prevalence in 2019. The prevalence in 2022 and 2023 were similar to the 2019 prevalence. Although no significant associations were found between US regions and the overall mean prevalence from 2019 to 2023; there was a difference in the average annual rate of change in prevalence by region, with a 4.0% lower rate in the Midwest compared to the Northeast ( p  < 0.001). This signifies a need to monitor future trends for potential regional differences., Conclusions: Drug use prevalence among individuals (age 16+) injured in non-fatal MVCs increased from 2019 to 2020; then decreased to levels reflecting baseline prevalence in 2019; with no significant regional differences in the overall mean crash-related drug use prevalence. These findings highlight the need for continuous surveillance across the US over an extended period. They also underscore the potential impact of environmental risk factors, such as the COVID-19 pandemic, and the necessity to monitor how drug use prevalence related to non-fatal MVCs changes in the coming years.

Background: Trauma is a major cause of death worldwide, especially in Low and Middle-Income Countries (LMIC). The increase in health care costs and the differences in the quality of provided services indicates the need for trauma care evaluation. This study was done to develop and use a performance assessment model for in-hospital trauma care focusing on traffic injures.Methods: This multi-method study was conducted in three main phases of determining indicators, model development, and model application. Trauma care performance indicators were extracted through literature review and confirmed using a two-round Delphi survey and experts' perspectives. Two focus group discussions and 16 semi-structured interviews were conducted to design the prototype. In the next step, components and the final form of the model were confirmed following pre-determined factors, including importance and necessity, simplicity, clarity, and relevance. Finally, the model was tested by applying it in a trauma center.Results: A total of 50 trauma care indicators were approved after reviewing the literature and obtaining the experts' views. The final model consisted of six components of assessment level, teams, methods, scheduling, frequency, and data source. The model application revealed problems of a selected trauma center in terms of information recording, patient deposition, some clinical services, waiting time for deposit, recording medical errors and complications, patient follow-up, and patient satisfaction.Conclusion: Performance assessment with an appropriate model can identify deficiencies and failures of services provided in trauma centers. Understanding the current situation is one of the main requirements for designing any quality improvement programs. [ABSTRACT FROM AUTHOR]

Background: The knowledge is scarce about sickness absence (SA) and disability pension (DP) among pedestrians injured in a traffic-related accident, including falls. Thus, the aim was to explore the frequencies of types of accidents and injuries and their association with SA and DP among working-aged individuals.Methods: A nationwide register-based study, including all individuals aged 16-64 and living in Sweden, who in 2010 had in- or specialized outpatient healthcare after a new traffic-related accident as a pedestrian. Information on age, sex, sociodemographics, SA, DP, type of accident, injury type, and injured body region was used. Frequencies of pedestrians with no SA or DP, with ongoing SA or full-time DP already at the time of the accident, and with a new SA spell >14 days in connection to the accident were analyzed. Crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for new SA were estimated by logistic regression.Results: In total, 5576 pedestrians received healthcare due to a traffic-related accident (of which 75% were falls, with half of the falls related to snow and ice). At the time of the accident, 7.5% were already on SA and 10.8% on full-time DP, while 20% started a new SA spell. The most common types of injuries were fractures (45%) and external injuries (30%). The body region most frequently injured was the lower leg, ankle, foot, and other (in total 26%). Older individuals had a higher OR for new SA compared with younger (OR 1.91; 95% CI 1.44-2.53, for ages: 45-54 vs. 25-34). The injury type with the highest OR for new SA, compared with the reference group external injuries, was fractures (9.58; 7.39-12.43). The injured body region with the highest OR for new SA, compared with the reference group head, face, and neck, was lower leg, ankle, foot, and other (4.52; 2.78-7.36).Conclusions: In this explorative nationwide study of the working-aged pedestrians injured in traffic-related accidents including falls, one fifth started a new SA spell >14 days. Fractures, internal injuries, collisions with motor vehicle, and falls related to snow and ice had the strongest associations with new SA. [ABSTRACT FROM AUTHOR]

Background: The aim of the present study was to analyze the prevalence, epidemiology and relevance of shoulder injuries in polytraumatized patients in a large national trauma database. We hypothesize a high prevalence of shoulder injuries in traffic accidents and a high prevalence of concomitant injuries of the thorax leading to an aggravated clinical course and higher Injury Severity Score (ISS). Furthermore, we hypothesize an increased rate of surgical treatment with the severity of the injury. Materials and methods: The retrospective analysis is based on the database (2002–2013) of the TraumaRegister DGU® and includes statistical data from 608 hospitals. The severity of injuries and trauma were scaled using the Abbreviated Injury Scale (AIS), and the Injury Severity Score (ISS), respectively. Patients with an ISS ≥ 16 were included in the study, and injuries were subdivided according to their anatomical involvement and analyzed with respect to the trauma mechanism and the resulting injuries. Results: In this study, 54,076 cases of patients with an ISS ≥ 16 were analyzed. Shoulder injuries occurred in 15,115 patients (27.9%). Of these, 68.5% were caused by traffic accidents, especially in motorbike, bicycle, and pedestrian accidents. We found more shoulder injuries in blunt trauma mechanisms. Moreover, patients with shoulder injuries spent on average 1.7 more days on the intensive care unit (ICU), or intermediate care unit (IMCU), according to the severity of the injury, and had longer overall hospital stays (26.2 vs. 24.1 days) than patients without shoulder injuries. The overall ISS was increased in patients with shoulder injuries, whereas an increase of mortality could not be identified. Concomitant thoracic injuries occurred significantly more often in patients with shoulder injuries (82.9% vs. 69.6%). Injuries of the abdomen, pelvis, and lower extremity showed no correlation with shoulder injuries, whereas head and spine injuries showed a significant correlation. Conclusion: Shoulder injuries are very common in polytraumatized patients. Together with their distinctive concomitant injuries, they have an aggravating impact on the clinical progress. Our data confirm the correlation with thoracic injuries. Furthermore, we identified an increased risk of shoulder injuries in motorbike, bicycle, and pedestrian accidents. An increase in mortality could not be identified. [ABSTRACT FROM AUTHOR]

Equal access to safe transport is increasingly conceptualised as a fundamental right for women, with demonstrated effects on health outcomes, social and economic mobility and societal participation. This study analysed qualitative and quantitative data to examine travel patterns and experiences among 200 women (aged between 18-64 years) using paid transport for work or educational purposes in Bangladesh. The results showed that the women faced multiple threats to their safety, including gender-based violence, harassment and crime, and traffic and non-traffic injuries, and that the use of paid transport was associated with high levels of anxiety and fear. Despite these circumstances, the women were captive travellers, forced to make transport choices based on price, availability and ease of travel rather than safety. Unable to choose safe transport, the women attempted to mitigate risks by changing their travel patterns and behaviour and by restricting their travel frequency. These findings are discussed within the context of women's rights and mobility justice. [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]

There is a disproportional risk of motor vehicle death and injury among American Indian/Alaska Native (AI/AN) populations in the United States. As home to the nation’s largest population of AI individuals, it is vital that California develop a better understanding of the factors contributing to this risk to guide the development and implementation of interventions to improve traffic safety for this population on the nearly 100 Rancherias and reservations in the state. However, there is very little data about the numbers and types of collisions, and driver and environmental factors contributing to the collisions that occur on tribal lands. As a first step toward better understanding the scope of the risk disparity, and the shortcomings in data collection, SafeTREC conducted a literature review and crash analysis using data from the Statewide Integrated Traffic Record System (SWITRS) and tribal area base maps targeting these communities. As a result of presentations and discussions at a California Tribal Safety conference where these analyses were presented, a number of procedural and institutional challenges were identified. Addressing these issues will not only help policymakers identify interventions to improve traffic safety on tribal lands, but it will give tribal jurisdictions tools to compete for scarce safety funding through the use of data documenting the need for safety improvements. Future research efforts should be aimed at refining these and other initiatives to address both the dire conditions of traffic safety on California’s tribal lands, and the limitations of the data.

Abstract Background Road traffic injuries (RTIs) have been one of the most critical public health problems in Thailand for decades. The objective of this study was to examine to what extent provincial economy was associated with RTIs, road traffic deaths and case fatality rate in Thailand. Methods A secondary data analysis on time-series data was applied. The unit of analysis was a panel of 77 provinces during 2012–2016. Data were obtained from relevant public authorities, including the Ministry of Public Health. Descriptive statistics and econometric models, using negative binomial (NB) regression, negative binomial regression with random-effects (RE) model, and spatial Durbin model (SDM) were employed. The main predictor variable was gross domestic product (GDP) per capita and the outcome variables were incidence proportion of RTIs, traffic deaths and case fatality rate. The analysis was adjusted for key covariates. Results The incidence proportion of RTIs rose from 449.0 to 524.9 cases per 100,000 population from 2012 till 2016, whereas the incidence of traffic fatalities fluctuated between 29.7 and 33.2 deaths per 100,000 population. Case fatality rate steadily stood at 0.06–0.07 deaths per victim. RTIs and traffic deaths appeared to be positively correlated with provincial economy in the NB regression and the RE model. In the SDM, a log-Baht increase in GDP per capita (equivalent to a growth of GDP per capita by about 2.7 times) enlarged the incidence proportion of injuries and deaths by about a quarter (23.8–30.7%) with statistical significance. No statistical significance was found in case fatality rate by the SDM. The SDM also presented the best model fitness relative to other models. Conclusion The incidence proportion of traffic injuries and deaths appeared to rise alongside provincial prosperity. This means that RTIs-preventive measures should be more intensified in economically well-off areas. Furthermore, entrepreneurs and business sectors that gain economic benefit in a particular province should share responsibility in RTIs prevention in the area where their businesses are running. Further studies that explore others determinants of road safety, such as patterns of vehicles used, attitudes and knowledge of motorists, investment in safety measures, and compliance with traffic laws, are recommended.

Abstract Background In recent years, bicycle injuries have increased, yet little is known about the impact of such injures on sickness absence (SA) and disability pension (DP). The aim was to explore SA and DP among individuals of working ages injured in a bicycle crash. Method A nationwide register-based study, including all individuals aged 16–64 years and living in Sweden, who in 2010 had in- or specialized out-patient healthcare (including emergency units) after a bicycle crash. Information on age, sex, sociodemographics, SA, DP, crash type, injury type, and injured body region was used. We analyzed individuals with no SA or DP, with ongoing SA or full-time DP already at the time of the crash, and with new SA > 14 days in connection to the crash. Crude and adjusted odds ratios (OR) with 95% confidence intervals for new SA were estimated by logistic regression. Results In total, 7643 individuals had healthcare due to a new bicycle crash (of which 85% were single-bicycle crashes). Among all, 10% were already on SA or full-time DP at the time of the crash, while 18% had a new SA spell. The most common types of injuries were external injuries (38%) and fractures (37%). The body region most frequently injured was the upper extremities (43%). Women had higher OR (1.40; 1.23–1.58) for new SA than men, as did older individuals compared with younger (OR 2.50; 2.02–3.09, for ages: 55–64 vs. 25–34). The injury types with the highest ORs for new SA, compared with the reference group external injuries was fractures (8.04; 6.62–9.77) and internal injuries (7.34; 3.67–14.66). Individuals with traumatic brain injury and injuries to the vertebral column and spinal cord had higher ORs for SA compared with other head, face, and neck injuries (2.72; 1.19–6.22 and 3.53; 2.24–5.55, respectively). Conclusions In this explorative nationwide study of new bicycle crashes among individuals of working ages, 18% had a new SA spell in connection to the crash while 10% were already on SA or DP. The ORs for new SA were higher among women, older individuals, and among individuals with a fracture.

Objective: The present review is intended to provide an up-to-date overview of the strategies available to detect malingered symptoms following whiplash. Whiplash-associated disorders (WADs) represent the most common traffic injuries, having a major impact on economic and healthcare systems worldwide. Heterogeneous symptoms that may arise following whiplash injuries are difficult to objectify and are normally determined based on self-reported complaints. These elements, together with the litigation context, make fraudulent claims particularly likely. Crucially, at present, there is no clear evidence of the instruments available to detect malingered WADs. Methods: We conducted a targeted literature review of the methodologies adopted to detect malingered WADs. Relevant studies were identified via Medline (PubMed) and Scopus databases published up to September 2020. Results: Twenty-two methodologies are included in the review, grouped into biomechanical techniques, clinical tools applied to forensic settings, and cognitive-based lie detection techniques. Strengths and weaknesses of each methodology are presented, and future directions are discussed. Conclusions: Despite the variety of techniques that have been developed to identify malingering in forensic contexts, the present work highlights the current lack of rigorous methodologies for the assessment of WADs that take into account both the heterogeneous nature of the syndrome and the possibility of malingering. We conclude that it is pivotal to promote awareness about the presence of malingering in whiplash cases and highlight the need for novel, high-quality research in this field, with the potential to contribute to the development of standardised procedures for the evaluation of WADs and the detection of malingering. [ABSTRACT FROM AUTHOR]