Assessment of patients' medical fitness to drive by primary care physicians: A cross-sectional study

Objectives: Motor vehicle collisions (MVCs) are a significant health burden in Saudi Arabia. The literature has consistently indicated that chronic medical conditions, such as diabetes, heart disease, stroke, obstructive sleep apnea, and neurodevelopmental disorders, increase the risk of MVCs. Therefore, assessment of driver fitness by primary care physicians (PCPs) remains a major health intervention that might reduce MVCs. We studied the practices of PCPs in assessing medical fitness to drive in at-risk patients.

Methods: We conducted a cross-sectional study of all 88 government-funded primary care centers in the city of Riyadh, Saudi Arabia. We administered a self-reported questionnaire to PCPs that inquired about their driving risk assessment for specific medical conditions.

Results: Among all PCPs and centers, 189 PCPs (63%) from 74 centers (84%) participated in our survey. The mean age of the PCPs was 40 ± 10 years, and 108 (57%) were men. The average clinical experience of the group was 13 ± 9 years. Fewer than half of PCPs considered diabetes mellitus (45%) and obstructive sleep apnea (46%) as potential risks for MVCs. Approximately 45% of PCPs did not notify any authority or relatives of potential driving issues that they noticed in their patients. Only 15% of the participants believed that PCPs were responsible for alerting authorities about their fitness to drive.

Conclusions: PCPs did not adequately assess their patients' driving history and eligibility. Efforts are needed to improve awareness among PCPs regarding the effects of chronic medical conditions on driving.     

Risk of serious injury of occupants involved in frontal crashes of cab-over-type trucks

Objectives: Truck vehicles (TVs) have a different structure and stiffness than non-TVs and are used commercially for transporting goods. This study aimed to analyze whether truck occupants have a greater risk of serious injury than those of other types of vehicles.

Methods: Crash data were obtained from the Korean In-Depth Data Analysis Study (KIDAS) for calendar years 2011–2016. Vehicles involved in frontal crash were included and classified into TVs and non-TVs (passenger cars and sports utility vehicles). We compared the demographic characteristics and serious injuries by body region between the 2 groups and analyzed factors that contributed to the serious injury severity from frontal crashes.

Results: The analysis was based on 884 occupants; 177 (20.0%) were in TVs and 707 (80.0%) were in non-TVs. Non-TVs had more frontal airbags deployments than TVs (50.9% vs. 3.4%, P <.01). TV occupants were 4.8 times more likely to have a serious lower extremity (LE) injury (adjusted odds ratio [AOR] = 4.820; 95% confidence interval [CI], 2.407–9.653) and 2.5 times to have a serious abdominal injury (AOR = 2.465; 95% CI, 1.108–5.487) compared to non-TV occupants.

Conclusions: Truck occupants had more serious LE and abdominal injuries than those of other types of vehicles in frontal crashes. Structural improvement and legislative efforts to develop safety systems are necessary to improve the safety of truck occupants.     

绿色交通与环境的可持续发展

汽车尾气是环境污染的重要来源之一。随着社会和人们对环境保护意识的增强,对道路交通汽车尾气的影响及防治越来越受到人们的重视。解决汽车污染问题．必须考虑中国国情,从环境保护、能源结构、城市建设（特别是道路建设）和汽车产业发展等方面入手,统筹使用清洁燃料、清洁的车辆技术,以及可持续的城市道路系统建设、环境管理措施,才能实现城市经济效益、社会效益和生态环境效益三者的统一。     

杭州交通噪声投诉点污染现状调查与防治

近年来杭州交通噪声投诉点主要分布在高架道路、立交桥和绕城高速附近的高层住户。对其中9个交通噪声投诉点的监测表明,昼间超4 a类标准的有4个,超标范围为0.1~7.6 dB;夜间9个点全部超4 a标准,超标范围为5.4~17.4 dB,夜间噪声超标特别严重。采用低噪声路面,设置隔声屏障,对敏感点安装通风隔声窗以及加强交通噪声管理等对策,可减轻交通噪声对敏感点的影响,从而减少交通噪声的投诉。     

北京市道路空气中NO_x现状监测及控制对策

通过对北京城市3种典型交通道路空气中NOx的时空变化监测发现,城市道路空气NOx中NO分担率主要集中在31.6%～81.1%,明显高于非交通道路中NO的分担率(3.0%～34.0%).其原因是NO主要来源于机动车尾气的排放.利用MOBILE软件计算了各类机动车排放的ρ(NOx),并相应地确定了影响交通道路中ρ(NOx)的敏感因素.据此提出了北京市交通道路空气中NOx若干控制措施,如控制车速、车型、油料等.     

事故车辆影响下的城市三车道道路交通流仿真

为探究事故车辆对城市三车道道路交通影响机制,首先,分析考虑事故车辆的城市三车道道路交通流特征;然后,构建左车道优先且考虑主动抢道和被动抢道行为的元胞自动机交通流模型;最后;研究事故持续时间td变化时事故车辆分别位于M道和R道的城市道路交通流演化。结果表明:事故车辆会形成交通瓶颈,呈现上游车辆聚集下游车辆稀疏的时空特征,诱发交通拥堵,事故车辆对三车道交通影响明显小于两车道情形;且事故车辆位于R车道对道路交通流影响比事故车辆位于M车道更小,但这种影响的差异随进车率pe增加而减小。     

Corporate occupational exposure limits: An example of a strategy

Occupational exposure limits (OELs) developed by authorities play a key role in the implementation of programs to protect workers against hazardous chemicals. Unfortunately, many hazardous substances do not have OELs or the OEL could be outdated. To assure the health of the workers, it is therefore useful for companies to develop corporate OELs. An inhouse strategy will be presented hereafter. Expertise in toxicology, industrial hygiene, and occupational health should be available within the company and clear selection criteria for substances are needed. A corporate OEL is only developed for hazardous substances (e.g., carcinogenic or reprotoxic) with a high potential for worker exposure when an appropriate national OEL or threshold limit value is not available. The methodology to calculate corporate OELs is based on the existing methods for national or community OELs and also on the guidance from the European Union's (EU) regulation on the Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH). For carcinogenic substances with a nonthreshold mode of action, there is always a residual chance that a cancer develops even when the exposure of workers is low. To establish an OEL for these substances, the “German traffic light model” is recommended. It is pragmatic, defines an unacceptable, tolerable, and acceptable risk level when workers are exposed to these substances, and determines risk management for exposure reduction. Overall, the professional practice to develop OELs is a good example of corporate leadership to proactively protect the health of workers.     

Importance of awareness in improving performance of emergency medical services (EMS) systems in enhancing traffic safety: A lesson from India

Objective: India has been slow in implementing a central emergency medical services (EMS) system across the country. “108 services” is one of the most popular services that is functional under the public–private partnership model. Limited available literature shows that despite access to services, many traffic crash victims are transported using private vehicles. The objective of this study is to understand the effectiveness of 108 services from a traffic safety perspective.

Method: A questionnaire survey is conducted to understand the awareness of EMS and their function. Using traffic-related fatalities as the dependent variable, a fixed effect panel data model is developed to analyze the effectiveness of the 108 services in improving the traffic safety.

Results: The results from the survey show that, in general, people are not aware of the 108 services. A majority of the population prefers taking victims to the hospital using their personal vehicles or any other vehicles available compared to calling an ambulance. Results from panel data analysis show that despite having an efficient system, these services failed to make significant improvement in the safety of road users in the states in which their services were subscribed.

Discussion: The lack of awareness of an important safety service is alarming. This could be a major reason for lower utilization of 108 services for transporting victims of traffic crashes. This article shows the importance of having efficient awareness campaigns to improve the efficiency of any similar programs that are aimed to enhance the safety of a region.     

Development of cycling skills in 7- to 12-year-old children

Objective: Cycling is a complex skill consisting of motor skills such as pedalling, braking, and steering. Because the ability to perform cycling skills is based on the age-related development of the child, experience and age-related reference values are of interest in light of customized testing and training.

Methods: One hundred thirty-eight children from the second (7–8 years), fourth (9–10 years), and sixth (11–12 years) grades performed a practical bicycle test consisting of 13 test items with specific points of interest. Moreover, age at onset of cycling, cycling to and from school, independent mobility, and minutes cycling per week were estimated using a parental questionnaire.

Results: It is found that cycling skills are strongly related to age with 11- to 12-year-old children outperforming 7- to 8-year-old children for 11 test items and 9- to 10-year-old children for 8 test items.

Conclusions: Next to age, age at onset of cycling also contributed to cycling skills. Therefore, our results suggest that cycling skills are associated with physical and mental maturation. Subsequently, age-related reference values are provided to customize testing and training.     

Estimated trends and patterns of road traffic fatalities in China, 2002–2012

Objective: This study examined the time trends and age distribution patterns of estimated road traffic fatalities (RTFs) in China over the period 2002–2012. Methods: Data on age-, sex-, and region-specific RTF rates were provided by the Chinese Ministry of Health. The crude rates were standardized and the Mann-Kendall test was used to test the significance of time trends. Annual number of RTFs was calculated. To minimize the effect of yearly variations, magnitude of changes in and age distribution patterns of the RTFs were examined using mean values of 2 years. Results: RTFs increased significantly in China during the study period. Several features were identified for the RTFs in China. First, RTF rates skyrocketed in rural areas including towns and counties. Second, a significant increase in RTFs was also observed in cities even though the change in RTF rates was not statistically significant there. Third, individuals aged 20–24, 40–49, and 55–64, especially in rural areas, were particularly at risk for RTFs in recent years. Finally, RTFs became more common among middle-aged and older adults than young Chinese, with roughly 57% of all RTFs occurring among individuals aged 45 and above during 2011–2012. Conclusions: RTFs increased dramatically in China during the past decade, especially in rural areas. Age distribution patterns of RTFs have changed there. Community-based public health education and intervention programs are warranted.