Objective: Though motor vehicle crashes (MVCs) were the main cause of head trauma from road traffic injuries (RTIs), motorcycle crashes (MCCs) are now a major cause of RTI-related head injury (HI) in many developing countries.
Methods: Using a prospective database of HIs from a neurosurgical practice in a sub-Saharan African developing country, a cross-sectional survey was conducted for the trauma demography and clinical epidemiology of this MCC-related HI.
Results: Motorcycle crashes accounted for 57% (473/833) of all RTI-related HIs in this registry. The victims, with a mean age of 33.1 years (SD = 18.3), consisted mainly of males (83.1%), those of low socioeconomic status (>90%), and those aged between 20 and 40 years old (56%). MCCs involved only riders in 114 cases (114/473, 32.1%), of which 69% were motorcycle–motorcycle crashes. The HI was moderate–severe in 50.8%; clinical symptomatology of significant HI included loss of consciousness (92%), anisocoria (35%), Abbreviated Injury Scale head (AIS–head) score > 3 (28%), and CT-Rotterdam score > 3 (30%). Extracranial systemic injury involved the limbs most frequently, with an Injury Severity Score (ISS) >25 in 49%. The fatality rate was 24%.
MCC-related HI among pedestrian victims involved more vulnerable age groups (the young and elderly) but have lower mean ISS compared to motorcycle passengers (mean ISS = 23.5 [11.6] vs. 27.4 [13.0]; 95% confidence interval [CI], 1.27–6.49; P = .004). In addition, compared to a contemporary cohort of MVC-related HIs in our registry, MCC victims were older (mean age 34.8 years [18.0] vs. 30.8 [18.4]; P = .002); had higher proportions of certain extracranial trauma like long bone fractures (71 vs. 29%; P = .02); and suffered fewer surgical brain lesions (25.5 vs. 17.2%; P = .004).
Conclusions: Motorcycle crashes are now a significant threat to the heads, limbs, and lives of vulnerable road users in developing countries. 相似文献
To examine parental decisions about vehicles driven by teenagers and parental knowledge of vehicle safety.
Methods
About 300 parents were interviewed during spring 2006 in Minnesota, North Carolina, and Rhode Island while teenagers took their first on-road driving tests.
Results
Fewer than half of parents surveyed said teenagers would be the primary drivers of the chosen vehicles. Parents most often cited safety, existing family vehicle, and reliability when explaining the choices for their teenagers’ vehicles. About half of the vehicles intended for teenagers were small/mini/sports cars, pickups, or SUVs — vehicles considered less safe for teenagers than midsize/large cars or minivans. A large majority of vehicles were 2001 models or earlier. Vehicles purchased in anticipation of adding a new driver to the family were more likely to be the sizes/types considered less safe than vehicles already owned. Few parents insisted on side airbags or electronic stability control, despite strong evidence of their safety benefits. Even when asked to identify ideal vehicles for their teenagers to drive, about half of parents identified less safe vehicle sizes/types. Most parents knew that midsize/large vehicles are safer than small vehicles, and at least half of parents said SUVs and pickups are not safe for teenage drivers, citing instability.
Conclusions
The majority of parents understood some of the important criteria for choosing safe vehicles for their teenagers. However, parents actually selected many vehicles for teenagers that provide inferior crash protection.
Impact on industry
Vehicle safety varies substantially by vehicle size, type, and safety features. Many teenagers are driving inferior vehicles in terms of crashworthiness and crash avoidance. 相似文献
This paper presents an innovative, quantitative assessment of pollution avoidance attributable to environmental regulation enforced through integrated licensing, using Ireland's pharmaceutical-manufacturing sector as a case study. Emissions data reported by pharmaceutical installations were aggregated into a pollution trend using an Environmental Emissions Index (EEI) based on Lifecycle Assessment methodologies. Complete sectoral emissions data from 2001 to 2007 were extrapolated back to 1995, based on available data. Production volume data were used to derive a sectoral production index, and determine ‘no-improvement’ emission trends, whilst questionnaire responses from 20 industry representatives were used to quantify the contribution of integrated licensing to emission avoidance relative to these trends. Between 2001 and 2007, there was a 40% absolute reduction in direct pollution from 27 core installations, and 45% pollution avoidance relative to hypothetical ‘no-improvement’ pollution. It was estimated that environmental regulation avoided 20% of ‘no-improvement’ pollution, in addition to 25% avoidance under business-as-usual. For specific emissions, avoidance ranged from 14% and 30 kt a− 1 for CO2 to 88% and 598 t a− 1 for SOx. Between 1995 and 2007, there was a 59% absolute reduction in direct pollution, and 76% pollution avoidance. Pollution avoidance was dominated by reductions in emissions of VOCs, SOx and NOx to air, and emissions of heavy metals to water. Pollution avoidance of 35% was attributed to integrated licensing, ranging from between 8% and 2.9 t a− 1 for phosphorus emissions to water to 49% and 3143 t a− 1 for SOx emissions to air. Environmental regulation enforced through integrated licensing has been the major driver of substantial pollution avoidance achieved by Ireland's pharmaceutical sector — through emission limit values associated with Best Available Techniques, emissions monitoring and reporting requirements, and performance targets specified in environmental management plans. This compliant sector offers a positive, but not necessarily typical, case study of IPPC effectiveness. 相似文献
Various indicators of health have been shown to be associated with traffic crash involvement. As general health is also related to absence from work, the latter variable may be more strongly related to crashes, especially for professional drivers.
Method
Bus driver absence from work was analyzed in association with their crash records. Two British samples and one Swedish sample were used.
Results
One of the British samples yielded fair correlations between crash record and absence, while for the other the effect was restricted to the first three months of driving. The Swedish data had effects in the expected direction but these were not significant.
Discussion
The use of an indirect, overall measurement of health, may be a viable method for predicting the traffic crash involvement for professional drivers, although replications are needed in larger samples and other populations.
Impact on industry
The use of absence records for the identification of at risk drivers would seem to be a simple and useful method for companies with major fleets, and it also shows the importance of promoting employee health and well being at work as a potential method of reducing the cost, not only of absenteeism, but also of crashes in company vehicles. 相似文献
Motor-vehicle crashes are a leading cause of death in the United States. In the event of a crash, seat belts are highly effective in preventing serious injury and death.
Methods
Data from the 2006 Behavioral Risk Factor Surveillance System were used to calculate prevalence of seat belt use by state and territory and by type of state seat belt law (primary vs. secondary enforcement).
Results
In 2006, seat belt use among adults ranged from 58.3% to 91.9% in the states and territories. Seat belt use was 86.0% in states and territories with primary enforcement laws and 75.9% in states with secondary enforcement laws.
Discussion
Seat belt use continues to increase in the United States. Primary enforcement laws remain a more effective strategy than secondary enforcement laws in getting motor-vehicle occupants to wear their seat belts. 相似文献