Assessment of occupational and environmental safety associated with medical waste disposal in developing countries: A qualitative approach

A carefully designed survey of medical waste management was undertaken in Dhaka, the capital city of Bangladesh. A range of sampling strategies and data gathering techniques were used. The data gathering techniques included observation, formal structured interview and informal dialogue. Sampling strategies included formal representative sampling for fixed populations and adaptive sampling for roaming populations was developed. Data were collected from healthcare establishments (HCEs) and other waste disposal operatives.Operatives dealing with waste were frequently found to be untrained, and without even a basic understanding of the hazards involved. Personal protective equipment was inadequate in most cases which led to frequent accidental injuries. No HCE was found to have adequate storage facilities for hazardous waste. Thus scavengers were able to gain access to items such as syringes and expired medicines, which they repackaged and resold. The lack of correctly controlled internal storage may be linked to the observation that employees at many HCEs offered contaminated items for sale to scavengers and recycling operatives. In many cases there was no attempt at segregation, but in some cases there was segregation at the point of use, but subsequent remixing with general waste, indicating a lack of management and education rather than a lack of will. In either case, hazardous waste was dumped in city corporation bins, and disposed of on general landfill sites. As well as exposing the waste to scavengers, this could potentially contaminate ground water, especially as the dumps were located in areas subject to frequent flooding.     

Motorcycle safety among motorcycle taxi drivers and nonoccupational motorcyclists in developing countries: A case study of Maoming,South China

Objective: An increasing number of motorcycle taxis have been involved in traffic crashes in many developing countries. This study examines the characteristics of both motorcycle taxi drivers and nonoccupational motorcyclists, investigates the risks they pose to road safety, and provides recommendations to minimize their risks.

Methods: Based on the data collected from a questionnaire survey of 867 motorcycle taxi drivers and 2,029 nonoccupational motorcyclists in Maoming, South China, comparisons were made to analyze differences of personal attributes, attitudes toward road safety, and self-reported behavior of the 2 groups.

Results: Results of the chi-square tests show that not only motorcycle taxi drivers but also nonoccupational motorcyclists in Maoming held poor attitudes toward road safety and both groups reported unsafe driving behavior. There is much room for improving local road safety education among all motorcyclists in Maoming. Yet, motorcycle taxi drivers were more likely to pose road safety risks than nonoccupational motorcyclists under some circumstances, such as speeding late at night or early in the morning, not requiring passengers to wear helmets, and running a red light. The results of the binary logistic regression model show that possessing a vehicle license for a motorcycle or not was the common significant predictor for unsafe driving behavior of motorcycle taxi drivers and nonoccupational motorcyclists. Therefore, enforcement against all motorcyclists not showing vehicle licenses for their motorcycles should be stepped up.

Conclusion: Motorcycle safety is largely poor in Maoming. Therefore, efforts to improve motorcycle safety should be strengthened by targeting not only motorcycle taxi drivers but also nonoccupational motorcyclists.     

Falls and fall prevention programmes in developing countries: environmental scan for the adaptation of the Canadian Falls prevention curriculum for developing countries

Problem

Falls in older persons in developing countries are poorly understood, and falls prevention and health promotion programmes for this population are largely lacking.

Methods

A systematic review was carried out of relevant literature on falls and prevention programmes, and falls prevention education, and a scan undertaken of health promotion programmes for older persons in a representative country - South Africa.

Results

Studies on the risk and prevalence of falls are largely retrospective and hospital-based, with varied methodology, including study period, sampling method and sample size. Falls prevalence is based largely on self-reports in studies on general trauma in all age groups. Falls incidence varies from 10.1% to 54%. No reports could be traced on sustained falls prevention or health promotion programmes.

Conclusion

Scant research has been conducted and little preventive education offered on falls in older persons. Adaptation of the Canadian Falls Prevention Curriculum for developing countries will help to fill gaps in knowledge and practice.

Impact on industry

With rapid increase in the populations of older persons in developing countries, research on age related disorders such as falls is required to guide policy and management of falls.     

Traffic rules and traffic safety

In the present paper the effects of traffic rules on driver behaviour and on traffic safety are discussed. The discussion is mainly based on research conerning driver’s use of safety equipment, their speed adjustment and drunken driving with respect to safety potential, effects of the rules, and effects of enforcement on driver behaviour. Factors influencing drivers’ decisions to comply with rules are also considered. It is concluded that only rules that are possible to enforce should be implemented and that police surveillance should be visible to the drivers. Also, the traffic system should be seen as a social system where drivers are interacting with other drivers and road users. Rules and regulations are important to help the actors of the system to function in a safe and effective way.     

Air Traffic Management accident risk. Part 2: Repairing the deficiencies of ESARR4

This is a critique of ESARR4 and its main supporting documents. ESARR4 is the Eurocontrol Safety Regulatory Requirement Number 4 [Eurocontrol safety regulatory requirement ESARR4, Edition 1.0., Eurocontrol, Safety Regulation Commission, Brussels, 2001]: ‘Risk assessment and mitigation in ATM’, ATM standing for Air Traffic Management. It is demonstrated that ESARR4 and its supporting documents are defective. There is a lack of clarity about responsibilities for ATM safety. The claims ESARR4 etc. make for its proposed methodologies are overstated—not supported by sound evidence from real world hazard analysis. Serious negative effects from this defective document include mis-allocation of scarce safety resources and the diversion of attention away from real safety improvements—wasteful of regulators’ and managers’ time. Suggestions are made for repairing these deficiencies. The most important underlying change would be a refocusing on practical safety assessment based on methods that have already demonstrated their merits.     

Benchmarking road safety performances of countries

In order to obtain political interest in road safety problems and to learn from other countries’ ‘good practices’, it is often helpful to compare one’s own safety situation with that of other countries. In a number of projects tools have been developed for such comparisons. These tools range from simple ratings of countries on their safety outcomes, such as the annual number of fatalities per capita or per kilometre driven by (motor)vehicles to more comprehensive comparisons.These comparisons not only show differences in safety between countries, but to a certain extent also explain such differences in terms of their safety background and measures taken. Finally, tools have been defined to support road safety policy makers in developing possible safety measures or actions. Procedures for such complex safety comparisons have been developed and tested in several so-called SUNflower studies.This promising approach can be further developed into standard procedures for safety comparisons between all countries in the European Union, and other countries worldwide. This paper wishes to outline the development of such standards for the benchmarking of road safety and safety trends as well as procedures for quantifying safety performances of countries.Starting point of this conceptual framework is the so-called SUNflower-pyramid in which three types of indicators are distinguished. The first one of these, the road safety performance indicator, is called an outcome indicator and is based on the number of killed and injured road users. The second indicator type indicates the quality of the implementation of road safety policies: the implementation performance indicators. The third type of indicator indicates the quality of response in policy documents to improve road safety (policy performance indicator). The three types of indicators are embedded in a policy context: the structure and culture of a country, which are considered as background variables.This paper sets out to describe the framework for the development of a comprehensive set of indicators to benchmark road safety performances of countries or of sub-national jurisdictions. The paper also discusses the advantages and disadvantages of combining such indicators and if combined, how to aggregate how different indicators in one composite performance index. It is argued to group countries in different classes with more or less comparable countries. Different procedures are used for this grouping. The results are promising and it is recommended to work with classes of countries.     

交通安全有法可依了

据报道,北京市2003年12月20日至2004年2月8日,共发生重大交通事故149起,死亡180人.今年春运期间广东省共发生一般以上交通事故9407起,死亡1169人,受伤8459人.每年发生的道路交通事故不知使多少人成为车下冤魂,夺去多少人的宝贵生命.这惊人的数字,血淋淋的事实,再一次给我们敲响了警钟,珍爱生命,请关注交通安全.     

Traffic safety in the U.S.: re-examining major opportunities

INTRODUCTION: This article examines five major road-safety risk factors: exceeding posted speed limits, not using safety belts, driving while intoxicated, nighttime driving, and young drivers. METHOD: The importance of each of these factors is documented, known effective countermeasures (both policy and technology based) are discussed, and impediments to the implementation of these countermeasures in the United States are examined. RESULTS: Based on current understanding of the five major risk factors, and of the available countermeasures, there appear to be a variety of opportunities to make substantial gains in road safety using existing knowledge. The limited implementation of a variety of known countermeasures therefore appears to be inconsistent with high-level, strategic goals to improve road safety. Consequently, a recommendation is made to comprehensively re-examine the balance between the countermeasures discussed in this article and economic, mobility, and privacy concerns. IMPACT ON PUBLIC SAFETY: Such a re-examination is likely to result in broad support for these countermeasures, with a consequent major improvement in road safety.     

Investigating safety of vulnerable road users in selected EU countries

Problem: Vulnerable road users comprise over half of all road accident victims in the EU and their safety situation is not improving as fast as for motorists. The paper examines factors affecting fatality risk of pedestrians, cyclists, motorcyclists, and moped riders in seven EU countries using data from CARE database. Method: Comparing accident severity indicators between countries is problematic because of data quality issues, different degree of underreporting, and different exposure levels. To avoid bias arising from these issues, fatality risk is modeled with binary logistic regression. Risk factors considered include accident location by area type, junction type, and traffic control, as well as lighting condition. Results are presented as odds ratios of fatal accident outcome in different countries under specific circumstances compared to reference conditions. It is shown that the error in OR values due to underreporting is small. Results and discussion: Wide confidence intervals of the odds ratios in some countries confirm problems with accident data quality. Fatality risk is always higher for non-urban versus urban area and for darkness versus daylight conditions, but the odds ratios are different for different countries. Inconsistent results are obtained for accident location with respect to junction and its control type. Possible reasons for these differences are suggested and discussed. Practical applications: The proposed method avoids the data quality bias of accident severity indicators, thus, it can be used in international comparisons of vulnerable road user accidents. The article findings also support the concept of changes in legislation, such as reducing the speed limit in urban areas in Poland at night. Generally, the experience of countries with low VRU fatality risk identified in the article can be transferred to those with a higher risk.     

Kletz's legacy for developing countries: Simple systems based on inherently safer design

The now well-known theory surrounding Inherently Safer Design (ISD) developed by Trevor Kletz has spread worldwide thanks to journals and almost unlimited communication between members of process safety all around the globe. This means that developing countries, such as Colombia, now have the possibility of applying it to their specific situations, which can often be resolved if the safety hierarchy is followed in order to attack problems from the design stage, a solution that might not seem instinctive, but is actually effective since there isn't a “reduction” strategy, but a removal of hazards. To apply this methodology to a specific Colombian case study, a previous quantitative risk analysis of an LPG storage tank farm in Colombia is revised and reformulated by developing an optimization (MINLP) based on the principles of inherent safety in order to design the same process (LPG pressurized storage) so that the available engineering tools can be used to mathematically formulate the inherent safety criteria. This allows determining the design conditions and safety measures needed to reduce the likelihood of an incident, being consistent with the Inherent Safety philosophy, which seeks a change of mental structure when designing processes, just like Trevor Kletz proposed and established as a new paradigm for Process Plants/Equipment design. The results of the project allow obtaining a specific optimal configuration of control, wall thickness, operating pressure and tank dimensions, pointing out a decrease of around 20% on the operating pressure.     

Costs of work-related musculoskeletal disorders (MSDs) in developing countries: Colombia case.

The real burden of occupational diseases, specifically work-related musculoskeletal disorders (MSDs), and its impact on workers' productivity is not known. The situation is critical in developing countries where only cases that cause workers' disability are recorded. In this study, the incidence of MSDs in Colombia was estimated by using the age and gender specific double incidence rate of repetitive strain injuries diseases in Finland for 2002. The results showed that the estimated number of MSDs recorded in Colombia during 2005 was 23,477 cases at the rate of 11.6 cases per 10,000 workers. The estimated total cost of these MSD cases relative to workers' productivity was 171.7 million US Dollars, representing around 0.2% of Colombia's Gross Domestic Product for 2005. The systematic appraisal of the incidence of MSDs and their associated cost on workers' productivity are necessary in developing countries to reduce the costly impact on productivity and to increase workers' well-being.     

Air Traffic Management accident risk. Part 1: The limits of realistic modelling

The prime goal of the Air Traffic Management (ATM) system is to control accident risk. Some key questions are posed, including: What do design safety targets really mean and imply for risk modelling? In what circumstances can future accident risk really be modelled with sufficient precision? If risk cannot be estimated with precision, then how is safety to be assured with traffic growth and operational/technical changes? This paper endeavours to answer these questions by an analysis of the nature of accidents, causal factors and practical collision risk modelling. The main theme is how best to combine sound safety evidence and real-world hazard analysis in a coherent and systematic framework.     

Traffic safety culture and prosocial driver behavior for safer vehicle-bicyclist interactions

Introduction: Bicyclist safety is a growing concern as more adults use this form of transportation for recreation, exercise, and mobility. Most bicyclist fatalities result from a crash with a vehicle. Often, the behaviors of the driver are responsible for the crash. Method: This survey study of Montana and North Dakota residents (n = 938) examined the influence of traffic safety culture on driver behaviors that affect safe interactions with bicyclists. Results: Prosocial driver behavior was most common and appeared to be intentional. Intention was increased by positive attitudes, normative perceptions, and perceived control. However, normative perceptions appear to offer the most opportunity for change. Practical Application: Strategies that increase perceptions that prosocial driver behavior is normal may increase prosocial intentions, thereby increasing bicyclist safety.     

Analysis of car-to-bicycle approach patterns for developing active safety devices

Objective: To reduce the severity of injuries and the number of cyclist deaths in traffic accidents, active safety devices providing cyclist detection are considered to be effective countermeasures. The features of car-to-bicycle collisions need to be known in detail to develop such safety devices.

Methods: The study investigated near-miss situations captured by drive recorders installed in passenger cars. Because similarities in the approach patterns between near-miss incidents and real-world fatal cyclist accidents in Japan were confirmed, we analyzed the 229 near-miss incident data via video capturing bicycles crossing the road in front of forward-moving cars. Using a video frame captured by a drive recorder, the time to collision (TTC) was calculated from the car's velocity and the distance between the car and bicycle at the moment when the bicycle initially appeared.

Results: The average TTC in the cases where bicycles emerged from behind obstructions was shorter than that in the cases where drivers had unobstructed views of the bicycles. In comparing the TTC of car-to-bicycle near-miss incidents to the previously obtained results of car-to-pedestrian near-miss incidents, it was determined that the average TTC in car-to-bicycle near-miss incidents was significantly longer than that in car-to-pedestrian near-miss incidents.

Conclusions: When considering the TTC in the test protocol of evaluation for safety performance of active safety devices, we propose individual TTCs for evaluation of cyclist and pedestrian detections, respectively. In the test protocols, the following 2 scenarios should be employed: bicycle emerging from behind an unobstructed view and bicycle emerging from behind obstructions.     

Measuring safety culture in a research and development centre: A comparison of two methods in the Air Traffic Management domain

This paper describes two safety surveys carried out in an Air Traffic Management Research and Development centre (EUROCONTROL Experimental Centre). The paper discusses the differences and similarities between the two tools with regard to their development, the method of conducting the surveys, the results and their implications. It has been estimated that about 50%¹ to 60%² of accidents and incidents appear to have their roots in the design and development process, and since this is the core business of the EEC, it was deemed necessary to investigate the maturity of safety at the EEC. The challenge for the EUROCONTROL Experimental Centre (EEC) was to develop a tool that is relevant to a research and development environment with the objectives of (i) identifying areas of weakness in the safety culture of the organization (ii) helping in developing a Safety Management System. The first objective was addressed by developing a Safety Culture Survey (SCS) tool and surveying the EEC (March, 2003). The second objective was addressed by customizing an existing (SMS) survey tool (RD) for the R&D environment. The SCS is based on traditional measures adapted to ATM and then to R&D, and the River Diagram (RD) is more of a safety management survey, adapted from other industries and already applied to HQ (EUROCONTROL Head Quarters) to examine their commitment to safety. Nevertheless, the two surveys have been compared to see where they agree and where they ‘dissociate’. Overall, the SCS has a broader focus on “softer issues”, i.e. more complex issues of ‘trust in management’. Diagnostically, the River Diagram survey helps the practitioner develop SMS implementation plans more readily than the Safety Culture survey.     

基于熵权模糊物元的高速公路路段安全综合评价

针对目前道路安全评价中信息屏蔽和主观性问题,利用模糊物元理论和熵权理论对高速公路安全水平进行了定量评价。在考虑影响道路安全水平多种因素基础上,构建了道路安全评价指标体系。以定量分析为主,将模糊物元、隶属函数及信息熵有机结合起来,建立了高速公路安全水平综合评价模型。以信息熵理论为基础确定了各评价指标的权重系数。将模型应用在新疆高速公路不同路段安全评价中,并与其它综合评价模型比较分析,验证该模型的有效性。研究结果表明该模型实用性强,计算过程简单,在道路安全评价中具有一定应用价值。