Abdominopelvic injuries due to road traffic accidents: Characteristics in a registry of 162,695 victims

Objective: Road traffic accidents (RTAs) are the first cause of abdominopelvic injuries (APIs). The objective of this study was to describe the characteristics and severity of APIs due to traffic accidents in a large French trauma registry and to identify risk factors for API.

Methods: All victims from the French Rhône registry of victims of RTAs were analyzed from 1996 to 2013. This registry contained data that were issued over a 20-year period from 245 medical departments, from prehospital care until re-adaptation, and forensic medicine departments. All APIs, defined as an injury between the diaphragm and the pelvic bone, were extracted and studied.

Results: Among 162,695 victims, 10,165 had an API (6.7%). Accidents frequently involved young men and 2 cars. Mean Injury Severity Score (ISS) was 8.7. Mortality rate was 5.6%. Soft tissue injuries largely predominated (n = 6,388; 54.4% of patients). Overall, 2,322 victims had a pelvic bone injury. Internal abdominal organs were involved in 2,425 patients; the most frequent were the spleen, liver, and kidney. Wearing of the seat belt appeared to be a significant protective factor in API, including serious injuries. A partial analysis over the past 2 years among the most severe patients hospitalized in the intensive care unit indicated that nonoperative management was carried out in two thirds of the wounded. In uni- or multivariate analysis, sex, age, type of user, antagonist, time of occurrence, associated severe lesions, or wearing of the seat belt were statistically associated with the occurrence of API, highlighting a more dangerous user profile.

Conclusions: Abdominopelvic injuries concern a minority of road traffic injuries, but they are responsible for significant mortality. Large solid organs are the most frequently affected. Women drivers wearing a seat belt and driving in town during the day appear to be more protected against API.     

Deprived neighborhoods and risk of road trauma (incidence and severity) among under 25year-olds in the Rhône Département (France)

Introduction

Previous research has shown that there are inequalities with regard to traffic accident risk between different social categories. This study describes the influence of the type of residential municipality (with or without deprived urban areas, “ZUS, zones urbaines sensibles”), used as an indicator of contextual deprivation, on the incidence and severity of road trauma involving people of under 25 years of age in the Rhône.

Method

Injury data were taken from The Rhône Road Trauma Registry. The study covers the 2004–2007 period, with 13,589 young casualties. The incidence of traffic injury of all severities were computed according to the type of municipality and the age, gender, and type of road user. The ratios of the incidences of deprived municipalities, compared with others were calculated. Subsequently the severity factors and incidences according to the severity level (ISS 1–8, ISS 9+) were studied.

Results

For the main types of road users except motorized two-wheeler users, the incidences were higher in the deprived municipalities: the greatest difference was for pedestrians, where the incidences were almost twice those of other municipalities. This excess risk, constituting a health inequality topic rarely considered, was even greater in municipalities with two or three ZUSs. It was essentially observed for minor injuries among motorists, cyclists, and pedestrians.

Conclusions

While the incidence increased among people less than 25 years of age, the severity of road injuries was lower in deprived neighborhoods, contrary to what is suggested by other studies. This lower severity disappeared when taking into account the crash characteristics.

Impact on industry

The incidence of injuries as a pedestrian, cyclist or motorist is higher among young people living in deprived municipalities. These areas should therefore be the targets of dedicated education programs, as well as further investigations about urban planning.     

Epidemiology of tornado destruction in rural northern Bangladesh: risk factors for death and injury

The epidemiology of tornado-related disasters in the developing world is poorly understood. An August 2005 post-tornado cohort study in rural Bangladesh identified elevated levels of death and injury among the elderly (≥ 60 years of age) (adjusted odds ratio (AOR) = 8.9 (95 per cent confidence interval (CI): 3.9-20.2) and AOR = 1.6 (95 per cent CI: 1.4-1.8), respectively), as compared to 15-24 year-olds, and among those outdoors versus indoors during the tornado (AOR = 10.4 (95 per cent CI: 5.5-19.9) and AOR = 6.6 (95 per cent CI: 5.8-7.5), respectively). Females were 1.24 times (95 per cent CI: 1.15-1.33) more likely to be injured than males. Elevated risk of injury was significantly associated with structural damage to the house and tin construction materials. Seeking treatment was protective against death among the injured, odds ratio = 0.08 (95 per cent CI: 0.03-0.21). Further research is needed to develop injury prevention strategies and to address disparities in risk between age groups and between men and women.     

Repetitive Strain in Nonrepetitive Work: A Case Study

In a Québec factory, a woman in a nontraditional job suffered from epicondylitis whereas her male coworkers were unaffected. A study was undertaken in order to enumerate the operations at risk for epicondylitis. Workers were interviewed in order to identify difficult operations and systematic observations were done over 4 work days. Although tasks were extremely varied, certain movements at risk for epicondylitis were repeated many times. Fifty-three valves were turned against resistance as part of this job, and one valve requiring a particularly difficult movement was turned 20 times in one day. There were at least 61 operations at risk for epicondylitis per day over a 4-day period. Strain on the elbow joint was particularly intense for the woman worker because the design of the workplace gave an advantage to taller workers with larger hands. Although this case study does not permit us to conclude that the worker’s epicondylitis was due to her job, it enables us to suggest that it would be wise to adapt the dimensions of relevant equipment and worksites to a wider range of potential worker sizes. We also raise some questions about the definition of repetitive strain in epidemiological studies. We suggest that it may be necessary to consider not only the cycle time but also the total of forces exerted on a joint in order to study workplace injuries to the musculoskeletal system.     

Structural anatomy and temporal trends of road accident research: Full-scope analyses of the field

Introduction: Scholarly research on road accidents over the past 50 years has generated substantial literature. We propose a robust search strategy to retrieve and analyze this literature. Method: Analyses was focused on estimating the size of this literature and examining its intellectual anatomy and temporal trends using bibliometric indicators of its articles. Results: The size of the literature is estimated to have exceeded N = 25,000 items as of 2020. At the highest level of aggregation, patterns of term co-occurrence in road accident articles point to the presence of six major divisions: (i) law, legislation & road trauma statistics; (ii) vehicular safety technology; (iii) statistical modelling; (iv) driving simulator experiments of driving behavior; (v) driver style and personality (social psychology); and (vi) vehicle crashworthiness and occupant protection division. Analyses identify the emergence of various research clusters and their progress over time along with their respective influential entities. For example, driver injury severity ” and crash frequency show distinct characteristics of trending topics, with research activities in those areas notably intensified since 2015 Also, two developing clusters labelled autonomous vehicle and automated vehicle show distinct signs of becoming emerging streams of road accident literature. Conclusions: By objectively documenting temporal patterns in the development of the field, these analyses could offer new levels of insight into the intellectual composition of this field, its future directions, and knowledge gaps. Practical Applications: The proposed search strategy can be modified to generate specific subsets of this literature and assist future conventional reviews. The findings of temporal analyses could also be instrumental in informing and enriching literature review sections of original research articles. Analyses of authorships can facilitate collaborations, particularly across various divisions of accident research field.     

The psychological impact of traffic injuries sustained in a road crash by bicyclists: A prospective study

Objective: The objective of this study was to investigate the psychological impact of traffic injuries in bicyclists (cyclists) in comparison to car occupants who also sustained traffic injuries. Factors predictive of elevated psychological distress were also investigated.

Methods: An inception cohort prospective design was used. Participants included cyclists aged ≥17 years (mean age 41.7 years) who sustained a physical injury (n = 238) assessed within 28 days of the crash, following medical examination by a registered health care practitioner. Injury included musculoskeletal and soft tissue injuries and minor/moderate traumatic brain injury (TBI), excluding severe TBI, spinal cord injury, and severe multiple fractures. Assessment also occurred 6 months postinjury. Telephone-administered interviews assessed a suite of measures including sociodemographic, preinjury health and injury factors. Psychological impact was measured by pain catastrophization, trauma-related distress, and general psychological distress. The psychological health of the cyclists was compared to that of the car occupants (n = 234; mean age 43.1 years). A mixed model repeated measures analysis, adjusted for confounding factors, was used to determine differences between groups and regression analyses were used to determine contributors to psychological health in the cyclists 6 months postinjury.

Results: Cyclists had significantly better psychological health (e.g., lower pain catastrophizing, lower rates of probable posttraumatic stress disorder [PTSD], and lower general distress levels) compared to car occupants at baseline and 6 months postinjury. Factors predictive of cyclists' psychological distress included younger age, greater perceived danger of death, poorer preinjury health, and greater amount of time in hospital after the injury.

Conclusions: These data provide insight into how cyclists perceive and adjust to their traffic injuries compared to drivers and passengers who sustain traffic injuries, as well as direction for preventing the development of severe psychological injury. Future research should examine the utility of predictors of psychological health to improve recovery.     

Association between resiliency and posttraumatic growth in firefighters: the role of stress appraisal

The purpose of this study was to establish the relation between resiliency and the level of positive changes, comprising posttraumatic growth in a group of firefighters experiencing job-related traumatic events and the mediating role of stress appraisal in this relation. The study was performed on a group of 100 firefighters from firefighting and rescue brigades, out of which 75 admitted to experiencing a traumatic event. Firefighters covered by the study were on average 31.51 years old (SD?=?6.34). A Polish version of Posttraumatic Growth Inventory, the Resiliency Assessment Scale and Stress Appraisal Questionnaire were used in the study. The results have shown that 22.7% of firefighters displayed low, 58.6% average and 18.7% high intensity of positive changes resulting from a traumatic event. Resiliency poorly correlates with posttraumatic growth expressed in changes in self-perception, and strongly correlates with stress appraisal, negatively correlates with threat and harm/loss and positively correlates with challenge. Appraisal of stress as a threat and challenge appeared to be mediators of the relationship between resiliency and posttraumatic growth.     

Avoiding cultural trauma: climate change and social inertia

ABSTRACT

The failure of societies to respond in a concerted, meaningful way to climate change is a core concern of the social science climate literature. Existing explanations of social inertia display little coherence. Here, a theoretical approach is suggested that integrates disparate perspectives on social inertia regarding climate change. Climate change constitutes a potential cultural trauma. The threat of cultural trauma is met with resistance and attempts to restore and maintain the status quo. Thus, efforts to avoid large-scale social changes associated with climate change constitute an effort to avoid cultural trauma, and result in social inertia regarding climate change at individual, institutional, and societal levels. Existing approaches to social inertia are reviewed. An intellectual framework utilizing the work of Pierre Bourdieu is proposed to integrate these different levels of social interaction. Social processes that maintain social order and thus avoid cultural trauma create social inertia regarding climate change.     

Ergonomic Risk Factors for Cumulative Trauma Disorders in VDU Operators

The objectives of this study were to investigate the rate of cumulative trauma disorders (CTDs) in the upper body and to describe the associations of such disorders with ergonomic parameters in a group of data entry operators. A total of 173 data entry operators volunteered to take part in the study. Questionnaires were used to investigate their medical history. Diagnoses of CTDs were made with clinical tests. A visual posture analysis of the workers and an ergonomic analysis of workstations and workload were used to reveal risk factors. Neck and shoulder pain, extensor tendonitis of the wrists and De Quervain’s disease were common in the study population. An assessment of risk factors showed that leaning wrists on the keyboard, hard keystrokes, extreme wrist joint and thumb positions and working in poor ergonomic design were correlated to pain and development of CTDs.