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Goel R, Tiwari G, Varghese M, Bhalla K, Agrawal G, Saini G, Jha A, John D, Saran A, White H, Mohan D. Effectiveness of road safety interventions: An evidence and gap map. Campbell Syst Rev 2024; 20:e1367. [PMID: 38188231 PMCID: PMC10765170 DOI: 10.1002/cl2.1367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Background Road Traffic injuries (RTI) are among the top ten leading causes of death in the world resulting in 1.35 million deaths every year, about 93% of which occur in low- and middle-income countries (LMICs). Despite several global resolutions to reduce traffic injuries, they have continued to grow in many countries. Many high-income countries have successfully reduced RTI by using a public health approach and implementing evidence-based interventions. As many LMICs develop their highway infrastructure, adopting a similar scientific approach towards road safety is crucial. The evidence also needs to be evaluated to assess external validity because measures that have worked in high-income countries may not translate equally well to other contexts. An evidence gap map for RTI is the first step towards understanding what evidence is available, from where, and the key gaps in knowledge. Objectives The objective of this evidence gap map (EGM) is to identify existing evidence from all effectiveness studies and systematic reviews related to road safety interventions. In addition, the EGM identifies gaps in evidence where new primary studies and systematic reviews could add value. This will help direct future research and discussions based on systematic evidence towards the approaches and interventions which are most effective in the road safety sector. This could enable the generation of evidence for informing policy at global, regional or national levels. Search Methods The EGM includes systematic reviews and impact evaluations assessing the effect of interventions for RTI reported in academic databases, organization websites, and grey literature sources. The studies were searched up to December 2019. Selection Criteria The interventions were divided into five broad categories: (a) human factors (e.g., enforcement or road user education), (b) road design, infrastructure and traffic control, (c) legal and institutional framework, (d) post-crash pre-hospital care, and (e) vehicle factors (except car design for occupant protection) and protective devices. Included studies reported two primary outcomes: fatal crashes and non-fatal injury crashes; and four intermediate outcomes: change in use of seat belts, change in use of helmets, change in speed, and change in alcohol/drug use. Studies were excluded if they did not report injury or fatality as one of the outcomes. Data Collection and Analysis The EGM is presented in the form of a matrix with two primary dimensions: interventions (rows) and outcomes (columns). Additional dimensions are country income groups, region, quality level for systematic reviews, type of study design used (e.g., case-control), type of road user studied (e.g., pedestrian, cyclists), age groups, and road type. The EGM is available online where the matrix of interventions and outcomes can be filtered by one or more dimensions. The webpage includes a bibliography of the selected studies and titles and abstracts available for preview. Quality appraisal for systematic reviews was conducted using a critical appraisal tool for systematic reviews, AMSTAR 2. Main Results The EGM identified 1859 studies of which 322 were systematic reviews, 7 were protocol studies and 1530 were impact evaluations. Some studies included more than one intervention, outcome, study method, or study region. The studies were distributed among intervention categories as: human factors (n = 771), road design, infrastructure and traffic control (n = 661), legal and institutional framework (n = 424), post-crash pre-hospital care (n = 118) and vehicle factors and protective devices (n = 111). Fatal crashes as outcomes were reported in 1414 records and non-fatal injury crashes in 1252 records. Among the four intermediate outcomes, speed was most commonly reported (n = 298) followed by alcohol (n = 206), use of seatbelts (n = 167), and use of helmets (n = 66). Ninety-six percent of the studies were reported from high-income countries (HIC), 4.5% from upper-middle-income countries, and only 1.4% from lower-middle and low-income countries. There were 25 systematic reviews of high quality, 4 of moderate quality, and 293 of low quality. Authors' Conclusions The EGM shows that the distribution of available road safety evidence is skewed across the world. A vast majority of the literature is from HICs. In contrast, only a small fraction of the literature reports on the many LMICs that are fast expanding their road infrastructure, experiencing rapid changes in traffic patterns, and witnessing growth in road injuries. This bias in literature explains why many interventions that are of high importance in the context of LMICs remain poorly studied. Besides, many interventions that have been tested only in HICs may not work equally effectively in LMICs. Another important finding was that a large majority of systematic reviews are of low quality. The scarcity of evidence on many important interventions and lack of good quality evidence-synthesis have significant implications for future road safety research and practice in LMICs. The EGM presented here will help identify priority areas for researchers, while directing practitioners and policy makers towards proven interventions.
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Affiliation(s)
- Rahul Goel
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | - Geetam Tiwari
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | | | - Kavi Bhalla
- Department of Public Health SciencesUniversity of ChicagoChicagoIllinoisUSA
| | - Girish Agrawal
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | | | - Abhaya Jha
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | - Denny John
- Faculty of Life and Allied Health SciencesM S Ramaiah University of Applied Sciences, BangaloreKarnatakaIndia
| | | | | | - Dinesh Mohan
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
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Bath MF, Hobbs L, Kohler K, Kuhn I, Nabulyato W, Kwizera A, Walker LE, Wilkins T, Stubbs D, Burnstein RM, Kolias A, Hutchinson PJ, Clarkson PJ, Halimah S, Bashford T. Does the implementation of a trauma system affect injury-related morbidity and economic outcomes? A systematic review. Emerg Med J 2024:emermed-2023-213782. [PMID: 38388191 DOI: 10.1136/emermed-2023-213782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/10/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Trauma accounts for a huge burden of disease worldwide. Trauma systems have been implemented in multiple countries across the globe, aiming to link and optimise multiple aspects of the trauma care pathway, and while they have been shown to reduce overall mortality, much less is known about their cost-effectiveness and impact on morbidity. METHODS We performed a systematic review to explore the impact the implementation of a trauma system has on morbidity, quality of life and economic outcomes, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All comparator study types published since 2000 were included, both retrospective and prospective in nature, and no limits were placed on language. Data were reported as a narrative review. RESULTS Seven articles were identified that met the inclusion criteria, all of which reported a pre-trauma and post-trauma system implementation comparison in high-income settings. The overall study quality was poor, with all studies demonstrating a severe risk of bias. Five studies reported across multiple types of trauma patients, the majority describing a positive impact across a variety of morbidity and health economic outcomes following trauma system implementation. Two studies focused specifically on traumatic brain injury and did not demonstrate any impact on morbidity outcomes. DISCUSSION There is currently limited and poor quality evidence that assesses the impact that trauma systems have on morbidity, quality of life and economic outcomes. While trauma systems have a fundamental role to play in high-quality trauma care, morbidity and disability data can have large economic and cultural consequences, even if mortality rates have improved. The sociocultural and political context of the surrounding healthcare infrastructure must be better understood before implementing any trauma system, particularly in resource-poor and fragile settings. PROSPERO REGISTRATION NUMBER CRD42022348529 LEVEL OF EVIDENCE: Level III.
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Affiliation(s)
- Michael F Bath
- International Health Systems Group, Department of Engineering, University of Cambridge, Cambridge, UK
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, Division of Academic Neurosurgery, University of Cambridge, Cambridge, UK
| | - Laura Hobbs
- International Health Systems Group, Department of Engineering, University of Cambridge, Cambridge, UK
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, Division of Academic Neurosurgery, University of Cambridge, Cambridge, UK
- Department of Anaesthesia, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Katharina Kohler
- International Health Systems Group, Department of Engineering, University of Cambridge, Cambridge, UK
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, Division of Academic Neurosurgery, University of Cambridge, Cambridge, UK
- Department of Perioperative, Acute, Critical Care, and Emergency Medicine, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Isla Kuhn
- University of Cambridge Medical Library, University of Cambridge, Cambridge, UK
| | - William Nabulyato
- International Health Systems Group, Department of Engineering, University of Cambridge, Cambridge, UK
| | - Arthur Kwizera
- Department of Anaesthesia and Intensive Care, Makerere University College of Health Sciences, Kampala, Uganda
| | - Laura E Walker
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tom Wilkins
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Daniel Stubbs
- Department of Perioperative, Acute, Critical Care, and Emergency Medicine, Department of Medicine, University of Cambridge, Cambridge, UK
| | - R M Burnstein
- Department of Perioperative, Acute, Critical Care, and Emergency Medicine, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Angelos Kolias
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, Division of Academic Neurosurgery, University of Cambridge, Cambridge, UK
| | - Peter John Hutchinson
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, Division of Academic Neurosurgery, University of Cambridge, Cambridge, UK
| | - P John Clarkson
- International Health Systems Group, Department of Engineering, University of Cambridge, Cambridge, UK
- Cambridge Public Health Interdisciplinary Research Centre, University of Cambridge, Cambridge, UK
| | - Sara Halimah
- Trauma Operational Advisory Team, World Health Organization, Cairo, Egypt
| | - Tom Bashford
- International Health Systems Group, Department of Engineering, University of Cambridge, Cambridge, UK
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, Division of Academic Neurosurgery, University of Cambridge, Cambridge, UK
- Department of Perioperative, Acute, Critical Care, and Emergency Medicine, Department of Medicine, University of Cambridge, Cambridge, UK
- Cambridge Public Health Interdisciplinary Research Centre, University of Cambridge, Cambridge, UK
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Crowe CS, Spinner RJ, Shin AY. Global trends and outcomes of nerve transfers for treatment of adult brachial plexus injuries. J Hand Surg Eur Vol 2024:17531934241232062. [PMID: 38372245 DOI: 10.1177/17531934241232062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
The presentation, management and outcomes of brachial plexus injuries are likely to be subject to regional differences across the globe. A comprehensive literature search was performed to identify relevant articles related to spinal accessory to suprascapular, intercostal to musculocutaneous, and ulnar and/or median nerve fascicle to biceps and/or brachialis motor branch nerve transfers for treatment of brachial plexus injuries. A total of 6007 individual brachial plexus injuries were described with a mean follow-up of 38 months. The specific indication for accessory to suprascapular and intercostal to musculocutaneous transfers were considerably different among regions (e.g. upper plexus vs. pan-plexal), while uniform for fascicular transfer for elbow flexion (e.g. upper plexus +/- C7). Similarly, functional recovery was highly variable for accessory to suprascapular and intercostal to musculocutaneous transfers, while British Medical Research Council grade ≥3 strength after fascicular transfer for elbow flexion was frequently obtained. Overall, differences in outcomes seem to be inherent to the specific transfer being utilized.Level of evidence: III.
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Affiliation(s)
- Christopher S Crowe
- Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, WA, USA
| | | | - Alexander Y Shin
- Division of Hand Surgery, Department of Orthopaedics, Mayo Clinic, Rochester, MN, USA
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Choi Y, Park JH, Ro YS, Jeong J, Kim YJ, Song KJ, Shin SD. Seat belt use and cardiac arrest immediately after motor vehicle collision: Nationwide observational study. Heliyon 2024; 10:e25336. [PMID: 38356526 PMCID: PMC10864909 DOI: 10.1016/j.heliyon.2024.e25336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 12/25/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024] Open
Abstract
Objective Motor vehicle collisions (MVCs) are known to cause traumatic cardiac arrest; it is unclear whether seat belts prevent this. This study aimed to evaluate the association between seat belt use and immediate cardiac arrest in cases of MVCs. Method This cross-sectional observational study used data from a nationwide EMS-based severe trauma registry in South Korea. The sample comprised adult patients with EMS-assessed severe trauma due to MVCs between 2018 and 2019. The primary, secondary, and tertiary outcomes were immediate cardiac arrest, in-hospital mortality, and death or severe disability, respectively. We calculated the adjusted odds ratios (AORs) of immediate cardiac arrest with seat belt use after adjusting for potential confounders. Results Among the 8178 eligible patients, 6314 (77.2 %) and 1864 (29.5 %) were wearing and not wearing seat belts, respectively. Immediate cardiac arrest, mortality, and death/severe disability rates were higher in the "no seat belt use" group than in the "seat belt use" group (9.4 % vs. 4.0 %, 12.4 % vs. 6.2 %, 17.7 % vs. 9.9 %, respectively; p < 0.001). The former group was more likely to experience immediate cardiac arrest (AOR [95 %CI]: 3.29 [2.65-4.08]), in-hospital mortality (AOR [95 %CI]: 2.72 [2.26-3.27]), and death or severe disability (AOR [95 %CI]: 2.40 [2.05-2.80]). Conclusion There was an association between wearing seat belts during MVCs and a reduced risk of immediate cardiac arrest.
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Affiliation(s)
- Yeongho Choi
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang, South Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, South Korea
| | - Jeong Ho Park
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, South Korea
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, South Korea
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Joo Jeong
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang, South Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, South Korea
| | - Yu Jin Kim
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang, South Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, South Korea
| | - Kyoung Jun Song
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, South Korea
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Sang Do Shin
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, South Korea
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
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Ghalichi L, Goodman-Palmer D, Whitaker J, Abio A, Wilson ML, Wallis L, Norov B, Aryal KK, Malta DC, Bärnighausen T, Geldsetzer P, Flood D, Vollmer S, Theilmann M, Davies J. Individual characteristics associated with road traffic collisions and healthcare seeking in low- and middle-income countries and territories. PLOS Glob Public Health 2024; 4:e0002768. [PMID: 38241424 PMCID: PMC10798533 DOI: 10.1371/journal.pgph.0002768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/05/2023] [Indexed: 01/21/2024]
Abstract
Incidence of road traffic collisions (RTCs), types of users involved, and healthcare requirement afterwards are essential information for efficient policy making. We analysed individual-level data from nationally representative surveys conducted in low- or middle-income countries (LMICs) between 2008-2019. We describe the weighted incidence of non-fatal RTC in the past 12 months, type of road user involved, and incidence of traffic injuries requiring medical attention. Multivariable logistic regressions were done to evaluate associated sociodemographic and economic characteristics, and alcohol use. Data were included from 90,790 individuals from 15 countries or territories. The non-fatal RTC incidence in participants aged 24-65 years was 5.2% (95% CI: 4.6-5.9), with significant differences dependent on country income status. Drivers, passengers, pedestrians and cyclists composed 37.2%, 40.3%, 11.3% and 11.2% of RTCs, respectively. The distribution of road user type varied with country income status, with divers increasing and cyclists decreasing with increasing country income status. Type of road users involved in RTCs also varied by the age and sex of the person involved, with a greater proportion of males than females involved as drivers, and a reverse pattern for pedestrians. In multivariable analysis, RTC incidence was associated with younger age, male sex, being single, and having achieved higher levels of education; there was no association with alcohol use. In a sensitivity analysis including respondents aged 18-64 years, results were similar, however, there was an association of RTC incidence with alcohol use. The incidence of injuries requiring medical attention was 1.8% (1.6-2.1). In multivariable analyses, requiring medical attention was associated with younger age, male sex, and higher wealth quintile. We found remarkable heterogeneity in RTC incidence, the type of road users involved, and the requirement for medical attention after injuries depending on country income status and socio-demographic characteristics. Targeted data-informed approaches are needed to prevent and manage RTCs.
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Affiliation(s)
- Leila Ghalichi
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Dina Goodman-Palmer
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - John Whitaker
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- King’s Centre for Global Health and Health Partnerships, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - Anne Abio
- Injury Epidemiology and Prevention Research Group, Turku Brain Injury Centre, Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- INVEST Research Flagship Center, University of Turku, Turku, Finland
| | - Michael Lowery Wilson
- Injury Epidemiology and Prevention Research Group, Turku Brain Injury Centre, Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
| | - Lee Wallis
- Clinical Services and Systems, Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - Bolormaa Norov
- Department of Nutrition and Food Safety, National Center for Public Health, Ulaanbaatar, Mongolia
| | - Krishna Kumar Aryal
- Bergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Deborah Carvalho Malta
- Universidade Federal de Minas Gerais, Departamento de Enfermagem Materno Infantil e Saúde Pública, Belo Horizonte, MG, Brasil
| | - Till Bärnighausen
- Institute of Global Health, Heidelberg University and University Hospital, Heidelberg, Germany
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California, United States of America
- Chan Zuckerberg Biohub–San Francisco, San Francisco, California, United States of America
| | - David Flood
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Michaela Theilmann
- Professorship of Behavioral Science for Disease Prevention and Health Care, Technical University of Munich, Munich, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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Ou Z, Wu K, Ruan Y, Zhang Y, Zhu S, Cui J, Gao Y, Jiang D, Tang S, Su Y, Ren Y, Duan D, Zhang J, Wang Z. Global burden and trends of three common road injuries from 1990 to 2019 and the implications for prevention and intervention. Accid Anal Prev 2023; 193:107266. [PMID: 37801816 DOI: 10.1016/j.aap.2023.107266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 06/09/2023] [Accepted: 08/14/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Analysis on the burden of specific types of road injuries (RIs) in the previous Global burden of disease (GBD) studies is lacking. The present work aimed to analyze the burden of three common RIs using the updated data of the GBD 2019, which would inform policy-making. METHODS Data on cyclist road injuries (CRIs), motorcyclist road injuries (MRIs), and motor vehicle road injuries (MVRIs) were extracted from the GBD 2019. Trends of age-standardized rate (ASR) were predicted using estimated annual percentage change (EAPC) from 1990 to 2019. RESULTS Over the past three decades, the global incident ASRs of CRIs and MRIs presented increasing trends, but that of MVRIs declined slightly. However, trends of death and disability adjusted life years (DALYs) caused by three common RIs decreased in most regions and countries. Particularly, trends in ASRs of years of life lost (YLLs) cuased by RIs decreased more pronouncedly than that of years of life lived with disability (YLDs). The burden of three common RIs showed significant social and demographic characteristics. Low-middle and middle socio-demographic index (SDI) areas had a heavy burden of RIs, particularly CRIs and MRIs. However, the high SDI area undertook a relatively low burden, and presented more pronounced downward trends in death and DALYs. CONCLUSIONS The burden and changing trends of three common RIs were geographically heterogeneous. The findings highlighted that increasing incident trends of RIs needed more cost-effective measures of prevention and intervention.
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Affiliation(s)
- Zejin Ou
- Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Kangyong Wu
- School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Yanmei Ruan
- Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Yuxia Zhang
- School of Basic Medicine and Public Health, Jinan University, Guangzhou, China
| | - Shaofang Zhu
- Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Jiaxin Cui
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Yunxia Gao
- School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Diwei Jiang
- School of Basic Medicine and Public Health, Jinan University, Guangzhou, China
| | - Shihao Tang
- Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Yiwei Su
- Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Yixian Ren
- Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Danping Duan
- Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Jinwei Zhang
- Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Zhi Wang
- Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital, Guangzhou, China.
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Psarras A, Panagiotidis T, Andronikidis A. The short-term impact of a referendum on motor vehicle collisions casualties. Traffic Inj Prev 2023; 25:65-69. [PMID: 37815789 DOI: 10.1080/15389588.2023.2262660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/19/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE A referendum took place in Greece on the 5th of July 2015 to decide whether the suggested bailout would be accepted. Since this was the first one since 1974, the period between the referendum and the subsequent national elections was characterized by increased uncertainty and had spillover effects in many aspects of everyday life. We take advantage of this quasi-experiment to investigate the short-term impact of the referendum on vehicle collisions casualties. METHODS We use data from the daily number of injuries and fatalities caused by vehicle collisions in 2015 and employ a difference-in-differences approach, comparing trends before and after the referendum. RESULTS We reveal that the referendum had a short-term impact on road traffic casualties (4.14 more casualties per day), compared to what would have been expected in the absence of the referendum. CONCLUSIONS The study provides evidence that negative emotions and anxiety, due to uncertainty, could promote dangerous driving behavior. Preventive and traffic control measures may need to be considered by policy makers during periods of uncertainty.
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Affiliation(s)
- Andreas Psarras
- Department of Business Administration, University of Macedonia, Thessaloniki, Greece
| | | | - Andreas Andronikidis
- Department of Business Administration, University of Macedonia, Thessaloniki, Greece
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Kamabu LK, Oboth R, Bbosa G, Baptist SJ, Kaddumukasa MN, Deng D, Lekuya HM, Kataka LM, Kiryabwire J, Moses G, Sajatovic M, Kaddumukasa M, Fuller AT. Predictive models for occurrence of expansive intracranial hematomas and surgical evacuation outcomes in traumatic brain injury patients in Uganda: A prospective cohort study. Res Sq 2023:rs.3.rs-3626631. [PMID: 38045250 PMCID: PMC10690308 DOI: 10.21203/rs.3.rs-3626631/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
BACKGROUND Hematoma expansion is a common manifestation of acute intracranial hemorrhage (ICH) which is associated with poor outcomes and functional status. Objective We determined the prevalence of expansive intracranial hematomas (EIH) and assessed the predictive model for EIH occurrence and surgical evacuation outcomes in patients with traumatic brain injury (TBI) in Uganda. Methods We recruited adult patients with TBI with intracranial hematomas in a prospective cohort study. Data analysis using logistic regression to identify relevant risk factors, assess the interactions between variables, and developing a predictive model for EIH occurrence and surgical evacuation outcomes in TBI patients was performed. The predictive accuracies of these algorithms were compared using the area under the receiver operating characteristic curve (AUC). A p-values of < 0.05 at a 95% Confidence interval (CI) was considered significant. Results A total of 324 study participants with intracranial hemorrhage were followed up for 6 months after surgery. About 59.3% (192/324) had expansive intracranial hemorrhage. The study participants with expansive intracranial hemorrhage had poor quality of life at both 3 and 6-months with p < 0.010 respectively. Among the 5 machine learning algorithms, the random forest performed the best in predicting EIH in both the training cohort (AUC = 0.833) and the validation cohort (AUC = 0.734). The top five features in the random forest algorithm-based model were subdural hematoma, diffuse axonal injury, systolic and diastolic blood pressure, association between depressed fracture and subdural hematoma. Other models demonstrated good discrimination with AUC for intraoperative complication (0.675) and poor discrimination for mortality (0.366) after neurosurgical evacuation in TBI patients. Conclusion Expansive intracranial hemorrhage is common among patients with traumatic brain injury in Uganda. Early identification of patients with subdural hematoma, diffuse axonal injury, systolic and diastolic blood pressure, association between depressed fracture and subdural hematoma, were crucial in predicting EIH and intraoperative complications.
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Connolly E, Kasomekera N, Sonenthal PD, Nyirenda M, Marsh RH, Wroe EB, Scott KW, Bukhman A, Minyaliwa T, Katete M, Banda G, Mukherjee J, Rouhani SA. Critical care capacity and care bundles on medical wards in Malawi: a cross-sectional study. BMC Health Serv Res 2023; 23:1062. [PMID: 37798681 PMCID: PMC10557270 DOI: 10.1186/s12913-023-10014-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/08/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION As low-income countries (LICs) shoulder a disproportionate share of the world's burden of critical illnesses, they must continue to build critical care capacity outside conventional intensive care units (ICUs) to address mortality and morbidity, including on general medical wards. A lack of data on the ability to treat critical illness, especially in non-ICU settings in LICs, hinders efforts to improve outcomes. METHODS This was a secondary analysis of the cross-sectional Malawi Emergency and Critical Care (MECC) survey, administered from January to February 2020, to a random sample of nine public sector district hospitals and all four central hospitals in Malawi. This analysis describes inputs, systems, and barriers to care in district hospitals compared to central hospital medical wards, including if any medical wards fit the World Federation of Intensive and Critical Care Medicine (WFSICCM) definition of a level 1 ICU. We grouped items into essential care bundles for service readiness compared using Fisher's exact test. RESULTS From the 13 hospitals, we analysed data from 39 medical ward staff members through staffing, infrastructure, equipment, and systems domains. No medical wards met the WFSICCM definition of level 1 ICU. The most common barriers in district hospital medical wards compared to central hospital wards were stock-outs (29%, Cl: 21% to 44% vs 6%, Cl: 0% to 13%) and personnel shortages (40%, Cl: 24% to 67% vs 29%, Cl: 16% to 52%) but central hospital wards reported a higher proportion of training barriers (68%, Cl: 52% to 73% vs 45%, Cl: 29% to 60%). No differences were statistically significant. CONCLUSION Despite current gaps in resources to consistently care for critically ill patients in medical wards, this study shows that with modest inputs, the provision of simple life-saving critical care is within reach. Required inputs for care provision can be informed from this study.
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Affiliation(s)
- Emilia Connolly
- , Abwenzi Pa Za Umoyo/Partners In Health, PO Box 56, Neno, Malawi.
- Division of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH, 45267, USA.
- Division of Hospital Medicine, Cincinnati Children's Hospital, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
| | - Noel Kasomekera
- , Abwenzi Pa Za Umoyo/Partners In Health, PO Box 56, Neno, Malawi
- Ministry of Health, P.O. Box 30377, Lilongwe 3, Malawi
| | - Paul D Sonenthal
- Partners In Health, 800 Boylston St Suite 300, Boston, MA, 02199, USA
- Brigham & Women's Hospital, Division of Pulmonary & Critical Care, 75 Francis St, Boston, MA, 02115, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Mulinda Nyirenda
- Adult Emergency and Trauma Centre, Queen Elizabeth Central Hospital, P.O. Box 95, Blantyre, Malawi
- University of Malawi College of Medicine, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Regan H Marsh
- Partners In Health, 800 Boylston St Suite 300, Boston, MA, 02199, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Brigham & Women's Hospital, Department of Emergency Medicine, 75 Francis St, Boston, MA, 02115, USA
| | - Emily B Wroe
- Partners In Health, 800 Boylston St Suite 300, Boston, MA, 02199, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Brigham & Women's Hospital, Division of Global Health Equity, 75 Francis St, Boston, MA, 02115, USA
| | - Kirstin W Scott
- Department of Emergency Medicine, University of Washington, Seattle, USA
| | - Alice Bukhman
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Brigham & Women's Hospital, Department of Emergency Medicine, 75 Francis St, Boston, MA, 02115, USA
| | - Tadala Minyaliwa
- , Abwenzi Pa Za Umoyo/Partners In Health, PO Box 56, Neno, Malawi
| | - Martha Katete
- , Abwenzi Pa Za Umoyo/Partners In Health, PO Box 56, Neno, Malawi
| | - Grace Banda
- Adult Emergency and Trauma Centre, Queen Elizabeth Central Hospital, P.O. Box 95, Blantyre, Malawi
| | - Joia Mukherjee
- Partners In Health, 800 Boylston St Suite 300, Boston, MA, 02199, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Shada A Rouhani
- Partners In Health, 800 Boylston St Suite 300, Boston, MA, 02199, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Brigham & Women's Hospital, Department of Emergency Medicine, 75 Francis St, Boston, MA, 02115, USA
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10
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Bhalla K, Job S, Mitra S, Harrison JE, Mbugua LW, Neki K, Gutierrez H, Balasubramaniyan R, Winer M, Vos T, Hamilton E. Assessing discrepancies in estimates of road traffic deaths in Brazil. Inj Prev 2023; 29:412-417. [PMID: 37208005 DOI: 10.1136/ip-2023-044871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/30/2023] [Indexed: 05/21/2023]
Abstract
INTRODUCTION The First UN Decade of Action for Road Safety (2011-2020) ended with most low/middle-income countries (LMICs) failing to reduce road traffic deaths. In contrast, Brazil reported a strong decline starting in 2012. However, comparisons with global health statistical estimates suggest that official statistics from Brazil under-report traffic deaths and overestimate declines. Therefore, we sought to assess the quality of official reporting in Brazil and explain discrepancies. METHODS We obtained national death registration data and classified deaths to road traffic deaths and partially specified causes that could include traffic deaths. We adjusted data for completeness and reattributed partially specified causes proportionately over specified causes. We compared our estimates with reported statistics and estimates from the Global Burden of Disease (GBD)-2019 study and other sources. RESULTS We estimate that road traffic deaths in 2019 exceeded the official figure by 31%, similar to traffic insurance claims (27.5%) but less than GBD-2019 estimates (46%). We estimate that traffic deaths have declined by 25% since 2012, close to the decline estimated by official statistics (27%) but much more than estimated by GBD-2019 (10%). We show that GBD-2019 underestimates the extent of recent improvements because GBD models do not track the trends evident in the underlying data. CONCLUSION Brazil has made remarkable progress in reducing road traffic deaths in the last decade. A high-level evaluation of what has worked in Brazil could provide important guidance to other LMICs.
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Affiliation(s)
- Kavi Bhalla
- Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | - Soames Job
- World Bank Global Road Safety Facility, World Bank, Washington, DC, USA
| | - Sudeshna Mitra
- World Bank Global Road Safety Facility, World Bank, Washington, DC, USA
| | | | | | - Kazuyuki Neki
- World Bank Global Road Safety Facility, World Bank, Washington, DC, USA
| | - Hialy Gutierrez
- Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | | | - Mercer Winer
- Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | - Theo Vos
- Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Erin Hamilton
- Institute for Health Metrics and Evaluation, Seattle, Washington, USA
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Case NF, Brown TG. Examining the predictive potential of depressed mood and alcohol misuse on risky driving. Alcohol Alcohol 2023; 58:532-538. [PMID: 37318107 PMCID: PMC10493518 DOI: 10.1093/alcalc/agad042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 05/02/2023] [Accepted: 05/23/2023] [Indexed: 06/16/2023] Open
Abstract
AIMS Male driving while impaired (DWI) offenders are at heightened risk for engaging in risky driving. Males in a depressed mood are also more prone to alcohol misuse, which may further contribute to risky driving. This manuscript investigates the predictive potential of combined depressed mood and alcohol misuse on risky driving outcomes 3 and 9 years after baseline in male DWI offenders. METHODS At baseline, participants completed questionnaires assessing depressed mood (Major Depression scale of the Millon Clinical Multiaxial Inventory-III), alcohol misuse (Alcohol Use Disorders Identification Test), and sensation-seeking (Sensation Seeking Scale-V). Risky driving data (Analyse des comportements routiers; ACR3) were collected at follow-up 3 years after baseline. Driving offence data were obtained for 9 years after baseline. RESULTS There were 129 participants. As 50.4% of the sample were missing ACR3 scores, multiple imputation was conducted. In the final regression model, R2 = 0.34, F(7,121) = 8.76, P < 0.001, alcohol misuse significantly predicted ACR3, B = 0.56, t = 1.96, P = 0.05. Depressed mood, however, did not significantly predict ACR3 and sensation-seeking was not a significant moderator. Although the regression model predicting risky driving offences at Year 9 was significant R2 = 0.37, F(10,108) = 6.41, P < 0.001, neither depressed mood nor alcohol misuse was a significant predictor. CONCLUSIONS These findings identify alcohol misuse as a predictor of risky driving 3 years after baseline among male DWI offenders. This enhances our prediction of risky driving, extending beyond the widely researched acute impacts of alcohol by exploring chronic patterns.
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Affiliation(s)
- Nevicia F Case
- Department of Psychiatry, McGill University, 1033 Pine Ave. W, Montreal, QC H3A 1A1, Canada
- Addiction Research Program, Douglas Mental Health University Institute, 6875 Boulevard LaSalle, Montreal, QC H4H 1R3, Canada
| | - Thomas G Brown
- Department of Psychiatry, McGill University, 1033 Pine Ave. W, Montreal, QC H3A 1A1, Canada
- Addiction Research Program, Douglas Mental Health University Institute, 6875 Boulevard LaSalle, Montreal, QC H4H 1R3, Canada
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Mesic A, Damsere-Derry J, Gyedu A, Mock C, Larley J, Opoku I, Wuaku DH, Kitali A, Osei-Ampofo M, Donkor P, Stewart B. Generating consensus on road safety issues and priorities in Ghana: A modified Delphi approach. Injury 2023; 54:110765. [PMID: 37193635 DOI: 10.1016/j.injury.2023.04.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/31/2023] [Accepted: 04/28/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Implementation of evidence-based approaches to reduce the substantial health, social, and financial burdens of road traffic injuries and deaths in Ghana and other low-and-middle-income countries (LMICs) is vitally important. Consensus from national stakeholders can provide insight into what evidence to generate and which interventions to prioritize for road safety. The main objective of this study was to elicit expert views on the barriers to reaching international and national road safety targets, the gaps in national-level research, implementation, and evaluation, and the future action priorities. MATERIALS AND METHODS We used an iterative three-round modified Delphi process to generate consensus among Ghanaian road safety stakeholders. We defined consensus as 70% or more stakeholders selecting a specific response in the survey. We defined partial consensus (termed "majority") as 50% or more stakeholders selecting a particular response. RESULTS Twenty-three stakeholders from different sectors participated. Experts generated consensus on barriers to road safety goals, including the poor regulation of commercial and public transport vehicles and limited use of technology to monitor and enforce traffic behaviors and laws. Stakeholders agreed that the impact of increasing motorcycle (2- and 3-wheel) use on road traffic injury burden is poorly understood and that it is a priority to evaluate road-user risk factors such as speed, helmet use, driving skills, and distracted driving. One emerging area was the impact of unattended/disabled vehicles along roadways. There was consensus on the need for additional research, implementation, and evaluation efforts of several interventions, including focused treatment of hazardous spots, driver training, road safety education as part of academic curricula, promotion of community involvement in first aid, development of strategically positioned trauma centers, and towing of disabled vehicles. CONCLUSION This modified Delphi process with stakeholders from Ghana generated consensus on road safety research, implementation, and evaluation priorities.
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Affiliation(s)
- Aldina Mesic
- Department of Global Health, University of Washington, Seattle, Washington, USA.
| | | | - Adam Gyedu
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Charles Mock
- Department of Global Health, University of Washington, Seattle, Washington, USA; Department of Surgery, University of Washington, Seattle, Washington, USA; Harborview Injury Prevention and Research Center, Seattle, Washington, USA
| | | | - Irene Opoku
- Building and Road Research Institute, Kumasi, Ghana
| | | | | | | | - Peter Donkor
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Barclay Stewart
- Department of Surgery, University of Washington, Seattle, Washington, USA; Harborview Injury Prevention and Research Center, Seattle, Washington, USA
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Martínez P, Joseph J, Nazif-Munoz JI. The absence of data on driving under the influence of alcohol in road traffic studies: a scoping review of non-randomized studies with vote counting based on the direction of effects of alcohol policies. Subst Abuse Treat Prev Policy 2023; 18:46. [PMID: 37507756 PMCID: PMC10375679 DOI: 10.1186/s13011-023-00553-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Data on driving under the influence of alcohol (DUIA) are not always available, accurate, or reliable, making it difficult to study the effects of alcohol policies on road traffic outcomes. The objectives of our study were twofold: 1) to describe how road traffic outcomes of alcohol policies are assessed when DUIA data are missing, and 2) to explore the effects of alcohol policies when DUIA data are missing. METHODS We conducted a scoping review of non-randomized studies that assessed the road traffic outcomes of alcohol policies when DUIA data are missing. Until November 2021, we searched studies published between 2000 and 2021, in English or French, via MEDLINE, APA PsycInfo, CINAHL, and SocINDEX. We assessed the risk of bias in the included studies with the Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group. The selection process, data extraction, and the risk of bias assessment were conducted independently and in duplicate. We used vote counting based on the direction of the effects of alcohol policies as a synthesis method. The protocol for this review was published in PROSPERO under record number CRD42021266744. RESULTS Twenty-four eligible studies were included. Regarding objective 1, most studies used uncontrolled interrupted time series designs to assess road traffic fatalities resulting from night-time crashes. The reasons for missing DUIA data were generally not reported. Regarding objective 2, we found evidence for an association between alcohol policies and decreased road traffic fatalities. Subgroup analyses found no evidence for an association between methodological modifiers and positive effect directions for road traffic fatalities. CONCLUSION Caution is needed when interpreting road traffic outcomes associated with alcohol policies when DUIA data are missing. Greater efforts should be made to improve the reporting of outcomes assessments. Future studies must address several methodological issues (e.g., more granular data, well-defined intervention and implementation, and controlled designs). Our results should be compared to those from others reviews where DUIA data were available to confirm or recalibrate the associations found in studies where DUIA data were missing.
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Affiliation(s)
- Pablo Martínez
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 150, Place Charles-Le Moyne, Longueuil, Québec, J4K A08, Canada.
- Centre de recherche Charles-Le Moyne-Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), 150, Place Charles-Le Moyne, Longueuil, Québec, J4K A08, Canada.
- Institut universitaire sur les dépendances, 950 Rue de Louvain Est, Montréal, Québec, H2M 2E8, Canada.
| | - Junon Joseph
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 150, Place Charles-Le Moyne, Longueuil, Québec, J4K A08, Canada
| | - José Ignacio Nazif-Munoz
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 150, Place Charles-Le Moyne, Longueuil, Québec, J4K A08, Canada
- Centre de recherche Charles-Le Moyne-Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), 150, Place Charles-Le Moyne, Longueuil, Québec, J4K A08, Canada
- Institut universitaire sur les dépendances, 950 Rue de Louvain Est, Montréal, Québec, H2M 2E8, Canada
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Sariaslan A, Larsson H, Hawton K, Pitkänen J, Lichtenstein P, Martikainen P, Fazel S. Physical injuries as triggers for self-harm: a within-individual study of nearly 250 000 injured people with a major psychiatric disorder. BMJ Ment Health 2023; 26:e300758. [PMID: 37380367 PMCID: PMC10577735 DOI: 10.1136/bmjment-2023-300758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/15/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Although there is robust evidence for several factors which may precipitate self-harm, the contributions of different physical injuries are largely unknown. OBJECTIVE To examine whether specific physical injuries are associated with risks of self-harm in people with psychiatric disorders. METHODS By using population and secondary care registers, we identified all people born in Finland (1955-2000) and Sweden (1948-1993) with schizophrenia-spectrum disorder (n=136 182), bipolar disorder (n=68 437) or depression (n=461 071). Falls, transport-related injury, traumatic brain injury and injury from interpersonal assault were identified within these subsamples. We used conditional logistic regression models adjusted for age and calendar month to compare self-harm risk in the week after each injury to earlier weekly control periods, which allowed us to account for unmeasured confounders, including genetics and early environments. FINDINGS A total of 249 210 individuals had been diagnosed with a psychiatric disorder and a physical injury during the follow-up. The absolute risk of self-harm after a physical injury ranged between transport-related injury and injury from interpersonal assault (averaging 17.4-37.0 events per 10 000 person-weeks). Risk of self-harm increased by a factor of two to three (adjusted OR: 2.0-2.9) in the week following a physical injury, as compared with earlier, unexposed periods for the same individuals. CONCLUSIONS Physical injuries are important proximal risk factors for self-harm in people with psychiatric disorders. CLINICAL IMPLICATIONS Mechanisms underlying the associations could provide treatment targets. When treating patients with psychiatric illnesses, emergency and trauma medical services should actively work in liaison with psychiatric services to implement self-harm prevention strategies.
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Affiliation(s)
- Amir Sariaslan
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Henrik Larsson
- School of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Keith Hawton
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Joonas Pitkänen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- International Max Planck Research School for Population Health and Data Science, Rostock, Germany
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Centre for Health Equity Studies (CHESS), Stockholm University and Karolinska Institutet, Stockholm, Sweden
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
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Alao DO, Cevik AA, Abu-Zidan FM. Trauma deaths of hospitalized patients in Abu Dhabi Emirate: a retrospective descriptive study. World J Emerg Surg 2023; 18:31. [PMID: 37118764 PMCID: PMC10148441 DOI: 10.1186/s13017-023-00501-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/19/2023] [Indexed: 04/30/2023] Open
Abstract
AIM To study the epidemiology and pattern of trauma-related deaths of hospitalized patients in Abu Dhabi Emirate, United Arab Emirates, in order to improve trauma management and injury prevention. METHODS The Abu Dhabi Trauma Registry prospectively collects data of all hospitalized trauma patients from seven major trauma centres in Abu Dhabi Emirate. We studied all patients who died on arrival or after admission to these hospitals from January 2014 to December 2019. RESULTS There were 453 deaths constituting 13.5% of all trauma deaths in the Abu Dhabi Emirate. The median (IQR) age of the patients was 33 (25-45) years, and 82% were males. 85% of the deaths occurred in the emergency department (ED) and the intensive care unit (ICU). Motor vehicle collision (63.8%) was the leading cause of death. 45.5% of the patients had head injury. Two of the seven hospitals admitted around 50% of all patients but accounted for only 25.8% of the total deaths (p < 0.001). Those who died in the ward (7%) were significantly older, median (IQR) age: of 65.5 (31.75-82.25) years, (p < 0.001), 34.4% of them were females (p = 0.09). The median (IQR) GCS of those who died in the ward was 15 (5.75-15) compared with 3 (3-3) for those who died in ED and ICU (P < 0.001). CONCLUSIONS Death from trauma predominantly affects young males with motor traffic collision as the leading cause. Over 85% of in-hospital deaths occur in the ICU and ED, mainly from head injuries. Injury prevention of traffic collisions through enforcement of law and improved hospital care in the ED and ICU will reduce trauma death.
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Affiliation(s)
- David O Alao
- Department of Internal Medicine, Section of Emergency Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
- The Department of Emergency Medicine, Tawam Hospital, Al-Ain, United Arab Emirates.
| | - Arif Alper Cevik
- Department of Internal Medicine, Section of Emergency Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
- The Department of Emergency Medicine, Tawam Hospital, Al-Ain, United Arab Emirates
| | - Fikri M Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
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Sadeghian Tafti MR, Ostovar A, Saeedi Moghaddam S, Shobeiri P, Ehrampoush MH, Salmani I, Khajeaminian MR, Fallahzadeh H, Dehghani Tafti A. Burden of road traffic injuries in Iran: a national and subnational perspective, 1990-2019. Inj Prev 2023; 29:101-110. [PMID: 36564169 PMCID: PMC10086501 DOI: 10.1136/ip-2022-044677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 09/10/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Reliable and valid information on burden of road traffic injuries (RTIs) is essential for short-term and long-term planning. We designed the present study to describe the levels and trends of burden of RTIs in Iran from 1990 to 2019. METHODS This is an observational epidemiological study. We used the Global Burden of Disease (GBD) 2019 estimates to report RTIs incidence, prevalence, mortality and disability-adjusted life-years (DALYs) by sex, age group and road user category in Iran and each of the 31 provinces from 1990 to 2019. RESULTS Age-standardised incidence, prevalence, death and DALY rates of RTIs decreased by 31.7% (95% uncertainty interval (UI): 29.4 to 33.9), 34.9% (33.8 to 36.0), 57.7% (48.1 to 62.3) and 60.1% (51.7 to 65.2), respectively between 1990 and 2019. The 2019 age-standardised DALY rates varied from smallest value in Tehran 303.8 (216.9 to 667.2) per 100 000 to largest value in Sistan-Baluchistan 2286.8 (1978.1 to 2627.9) per 100 000. The burden of RTIs was mainly related to injuries sustained by drivers or passengers of motorised vehicles with three or more wheels and pedestrians' injuries, mostly affected males aged 15-29 years and individuals aged ≥70 years. CONCLUSION The reducing trend in the burden of RTIs in Iran possibly reflects the effectiveness of the intervention programmes. However, with regard to the Sustainable Development Goals the burden is still at an alarming level. Further reductions are necessary for specific road user groups such as adolescent and adult male drivers or passengers of motorised vehicles, also pedestrians aged ≥70 years.
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Affiliation(s)
- Mohammad Reza Sadeghian Tafti
- Department of Health in Disaster and Emergencies, School of public health, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Parnian Shobeiri
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hassan Ehrampoush
- Department of Environmental Health, School of public health, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | - Ibrahim Salmani
- Department of Health in Disaster and Emergencies, School of public health, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | - Mohammad Reza Khajeaminian
- Department of Health in Disaster and Emergencies, School of public health, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | - Hossein Fallahzadeh
- Center for Healthcare Data Modeling, Departments of biostatistics and Epidemiology, School of public health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Abbasali Dehghani Tafti
- Department of Health in Disaster and Emergencies, School of public health, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
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Guimarães RA, de Sena KG, de Morais Neto OL, Malta DC. Magnitude and factors associated with motor road traffic injuries in Brazil: Results from the National Health Survey, 2019. Injury 2023:S0020-1383(23)00244-9. [PMID: 36934008 DOI: 10.1016/j.injury.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 03/03/2023] [Accepted: 03/05/2023] [Indexed: 03/20/2023]
Abstract
OBJECTIVE To estimate the magnitude and factors associated with self-reported road traffic injuries (RTI) in Brazil. METHODS Cross-sectional study conducted using data from individuals aged 18 years or older, participants in the 2019 National Health Survey, a population-based conducted on 88,531 adult individuals in Brazil. Three indicators were analyzed: (i) Proportion (%) of individuals aged 18 years or older who were involved in RTI in the past 12 months; (ii) Proportion (%) of car drivers who were involved in RTI in the past 12 months; and (iii), Proportion (%) of motorcycle drivers who were involved in RTI in the past 12 months. In the inferential analysis, multiple Poisson regression was used to analyze the association between demographic and socioeconomic variables and RTI, stratified for the general population, population of car and motorcycle drivers. RESULTS The estimated prevalence of self-reported RTI in the past 12 months was 2.4%. The South, Southeast, Northeast, Central-West, and North regions of Brazil had prevalences of 2.0%, 2.1%, 2.7%, 3.2%, and 3.4%, respectively. The results also show that most developed regions (South and Southeast) showed the lowest prevalence's, the highest frequencies were observed in those with lower socioeconomic development levels (Central-West, North, and Northeast). The prevalence was also higher in the subgroup of motorcyclists when compared to car drivers. In the general sample, the Poisson model showed an association between male sex, younger age, low level of education, residing outside capitals and metropolitan regions, in the North, Northeast and South regions and the prevalence of RTI. In car drivers, similar associations were found, except for area of residence. In motorcycle drivers, young age, low level of education, living in urban areas were associated with increased prevalence of RTI. CONCLUSION The prevalence of RTI is still high within the country, with disparities between regions, affecting more motorcyclists, young people, males, individuals with low education, and residents of the countryside.
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Affiliation(s)
- Rafael Alves Guimarães
- Faculdade de Enfermagem. Universidade Federal de Goiás, Goiânia, Goiás, Brasil; Instituto de Patologia Tropical e Saúde Pública. Universidade Federal de Goiás, Goiânia, Goiás, Brasil.
| | - Kamylla Guedes de Sena
- Instituto de Patologia Tropical e Saúde Pública. Universidade Federal de Goiás, Goiânia, Goiás, Brasil
| | | | - Deborah Carvalho Malta
- Departamento de Enfermagem Materno Infantil e Saúde Pública. Escola de Enfermagem. Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
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Ganga A, Kim EJ, Tang OY, Feler JR, Sastry RA, Anderson MN, Keith SE, Fridley JS, Gokaslan ZL, Cielo DJ, Toms SA, Sullivan PZ. The burden of unhelmeted motorcycle injury: A nationwide scoring-based analysis of helmet safety legislation. Injury 2023; 54:848-856. [PMID: 36646531 DOI: 10.1016/j.injury.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/28/2022] [Accepted: 01/02/2023] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Motorcycle collisions comprise a large portion of motor vehicle injuries and fatalities with over 80,000 injuries and 5,500 fatalities per year in the United States. Unhelmeted riders have poor medical outcomes and generate billions in costs. Despite helmet use having been shown to lower the risk of neurological injury and death, helmet compliance is not universal, and legislation concerning helmet use also varies widely across the United States. METHODS In this study, we systematically reviewed helmet-related statutes from all US jurisdictions. We evaluated the stringency of these statutes using a legislative scoring system termed the Helmet Safety Score (HSS) ranging from 0-7 points, with higher scores denoting more stringent statutes. Regression modeling was used to predict unhelmeted mortality using our safety scores. RESULTS The mean score across all jurisdictions was 4.73. We found jurisdictions with higher HSS's generally had lower percentages of unhelmeted fatalities in terms of total fatalities as well as per 100,000 people and 100,000 registered motorcycles. In contrast, some lower-scoring jurisdictions had over 100 times more unhelmeted fatalities than higher-scoring jurisdictions. Our HSS significantly predicted unhelmeted motorcycle fatalities per 100,000 people (β = -0.228 per 1-point increase, 95% CI: -0.288 to -0.169, p < .0001) and per 100,000 registered motorcycles (β = -6.17 per 1-point increase, 95% CI: -8.37 to -3.98, p < .0001) in each state. Aspects of our score concerning helmet exemptions for riders and motorcycle-type vehicles independently predicted higher fatalities (p < .0001). Higher safety scores predicted lower unhelmeted fatalities. CONCLUSION Stringent helmet laws may be an effective mechanism for decreasing unhelmeted mortality. Therefore, universal helmet laws may be one such mechanism to decrease motorcycle-related neurological injury and fatality burden. In states with existing helmet laws, elimination of exemptions for certain riders and motorcycle-type vehicles may also decrease fatalities.
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Affiliation(s)
- Arjun Ganga
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Eric J Kim
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Oliver Y Tang
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Joshua R Feler
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Rahul A Sastry
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Matthew N Anderson
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Sharonda E Keith
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Jared S Fridley
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Ziya L Gokaslan
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Deus J Cielo
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Steven A Toms
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Patricia Zadnik Sullivan
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States.
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Secades JJ, Trimmel H, Salazar B, González JA. Citicoline for the Management of Patients with Traumatic Brain Injury in the Acute Phase: A Systematic Review and Meta-Analysis. Life (Basel) 2023; 13. [PMID: 36836726 DOI: 10.3390/life13020369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/18/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Citicoline or CDP-choline is a neuroprotective/neurorestorative drug used in several countries for the treatment of traumatic brain injury (TBI). Since the publication of the controversial COBRIT, the use of citicoline has been questioned in this indication, so it was considered necessary to undertake a systematic review and meta-analysis to evaluate whether citicoline is effective in the treatment of patients with TBI. METHODS A systematic search was performed on OVID-Medline, EMBASE, Google Scholar, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and Ferrer databases, from inception to January 2021, to identify all published, unconfounded, comparative clinical trials of citicoline in the acute phase of head-injured patients- that is, treatment started during the first 24 h. We selected studies on complicated mild, moderate, and severe head-injured patients according to the score of the Glasgow Coma Scale (GCS). The primary efficacy measure was independence at the end of the scheduled clinical trial follow-up. RESULTS In total, 11 clinical studies enrolling 2771 patients were identified by the end. Under the random-effects model, treatment with citicoline was associated with a significantly higher rate of independence (RR, 1.18; 95% CI = 1.05-1.33; I2, 42.6%). The dose of citicoline or the administration route had no effect on outcomes. Additionally, no significant effects on mortality were found, and no safety concerns were noticed. CONCLUSIONS This meta-analysis indicates some beneficial effects of citicoline's increasing the number of independent patients with TBI. The most important limitation of our meta-analysis was the presumed heterogeneity of the studies included. REGISTRATION PROSPERO CRD42021238998.
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He L, Liu C, Shan X, Zhang L, Zheng L, Yu Y, Tian X, Xue B, Zhang Y, Qin X, Wang C, Zhang K, Luo B. Impact of high temperature on road injury mortality in a changing climate, 1990-2019: A global analysis. Sci Total Environ 2023; 857:159369. [PMID: 36228793 DOI: 10.1016/j.scitotenv.2022.159369] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/23/2022] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Previous studies have shown that extreme heat likely increases the risk of road injuries. However, the global burden of road injuries due to high temperature and contributing factors remain unclear. This study aims to characterize the global, regional and national burden of road injuries due to high temperature from 1990 to 2019. METHODS Based on the Global Burden of Disease (GBD) study 2019, we obtained the numbers and age-standardized mortality rates (ASMR) and age-standardized disability-adjusted life years (DALY) rates (ASDR) of the road injury due to high temperature at global, regional, and national levels from 1990 to 2019. The world is divided into five climate zones according to the average annual temperature of each country: tropical, subtropical, warm temperate, cold temperate, and boreal. We used the generalized additive models (GAM) to model the trends of road injuries globally and by region. RESULTS Globally, between 1990 and 2019, the deaths of road injury attributable to high temperature increased significantly from 20,270 (95% uncertainty interval [UI], 7836 to 42,716) to 28,396 (95% UI, 13,311 to 51,178), and the DALYs increased from 1,169,309 (95% UI, 450,834 to 2,491,075) to 1,414,527 (95% UI, 658,347 to 2,543,613). But the ASMR and the ASDR slightly decreased by 8.49% and 13.16%, respectively. The burden of road injury death attributable to high temperature remained high in low SDI and tropical regions. In addition, road transport infrastructure investment per inhabitant is associated with the burden of road injuries attributable to high temperature. CONCLUSIONS Globally, the ASMR and ASDR for road injuries attributable to high temperature decreased from 1990 to 2019, but the absolute death and DALYs continued to increase. Thus, concerning global warming, implementation of prevention and interventions to reduce road injuries from heat exposure should be stressed globally.
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Affiliation(s)
- Li He
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, People's Republic of China
| | - Ce Liu
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, People's Republic of China
| | - Xiaobing Shan
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, People's Republic of China
| | - Ling Zhang
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, People's Republic of China
| | - Ling Zheng
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, People's Republic of China
| | - Yunhui Yu
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, People's Republic of China
| | - Xiaoyu Tian
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, People's Republic of China
| | - Baode Xue
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, People's Republic of China
| | - Yu Zhang
- Department of Civil and Environmental Engineering, University of South Florida, Tampa, FL 33620, USA
| | - Xiao Qin
- Department of Civil and Environmental Engineering, University of Wisconsin-Milwaukee, Milwaukee, WI 53201, USA
| | - Cara Wang
- Department of Civil and Environmental Engineering, Rensselaer Polytechnic Institute, Troy, NY 12211, USA
| | - Kai Zhang
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, NY 12144, USA.
| | - Bin Luo
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, People's Republic of China; Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Bureau, Shanghai 200030, People's Republic of China; Shanghai Typhoon Institute, China Meteorological Administration, Shanghai 200030, People's Republic of China.
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Joseph AP, Wallman M, Scott E, Ilchef R, Harris N, Jackson A, Bryant RA. A proof-of-concept randomized controlled trial of follow-up mental health care for traumatic injury patients following hospital discharge. Injury 2023; 54:1362-1368. [PMID: 36858896 DOI: 10.1016/j.injury.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 12/14/2022] [Accepted: 01/01/2023] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Traumatic injuries account for a huge burden of disease. Many patients develop persistent mental health problems in the months following hospital discharge. This proof-of-concept trial investigated whether Stepped Care comprising follow-up assessment telephone calls and appropriate referral information would lead to better mental health and functioning in traumatic injury patients. METHODS Patients admitted to the Trauma Service at Royal North Shore Hospital were randomized to either Stepped Care (n = 84) or Treatment as Usual (n = 90). All patients were assessed for anxiety, depression, and posttraumatic stress prior to hospital discharge. Those in Stepped Care received a telephone call at 1-month and 3-months after hospital discharge in which they were administered a brief assessment; patients who reported mental health or pain difficulties were provided with information for local specialists to address their specific problem. All patients were independently assessed by telephone interview 9- months after hospital discharge for posttraumatic stress disorder (PTSD) (primary outcome), as well as for anxiety, depression, disability, and pain. RESULTS There were 58 (73%) patients that could be contacted at either the 1-month or 3-month assessments. Of those contacted, 28 patients (48% of those contacted) were referred for specialist assistance. There were no differences between treatment arms on PTSD symptoms at follow-up [F1,95 = 0.55, p = 0.46]. At the 9-month assessment, patients in the Stepped Care condition reported significantly less anxiety [F1,95 = 5.07, p = 0.03] and disability [F1,95 = 4.37, p = 0.04] relative to those in Treatment as Usual. At 9 months there was no difference between conditions on depression [F1,95 = 1.03, p = 0.31]. There were no differences between conditions on self-reported pain difficulties. CONCLUSIONS This proof-of-concept trial suggests that brief screening assessments of traumatic injury patients following hospital discharge, combined with appropriate referral information, may lead to better functional outcomes. Further research is needed with larger sample sizes and greater verification of referral uptake to validate this finding.
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Affiliation(s)
- Anthony P Joseph
- Trauma Service, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
| | - Matthew Wallman
- Trauma Service, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Elliot Scott
- Trauma Service, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Ralf Ilchef
- Department of Psychiatry, Royal North Shore Hospital, St Leonards, NSW 2065
| | - Newman Harris
- Department of Pain Management, Royal North Shore Hospital, St Leonards, NSW 2065
| | - Alicia Jackson
- Trauma Service, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia
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Mesic A, Gyedu A, Mehta K, Goodman SK, Mock C, Quansah R, Donkor P, Stewart B. Factors Contributing to and Reducing Delays in the Provision of Adequate Care in Ghana: A Qualitative Study of Trauma Care Providers. World J Surg 2022; 46:2607-2615. [PMID: 35994075 PMCID: PMC10424506 DOI: 10.1007/s00268-022-06686-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Ghana has a large and growing burden of injury morbidity and mortality. There is a substantial unmet need for trauma surgery, highlighting a need to understand gaps in care. METHODS We conducted 8 in-depth interviews with trauma care providers (surgeons, nurses, and specialists) at a large teaching hospital to understand factors that contribute to and reduce delays in the provision of adequate trauma care for severely injured patients. The study aimed to understand whether providers thought factors differed between patients that were enrolled in the National Health Insurance Scheme (NHIS) and those that were not. Findings were presented for the third delay (provision of appropriate care) in the Three Delays Framework. RESULTS Key findings included that most factors contributing delays in the provision of adequate care were related to the costs of care, including for diagnostics, medications, and treatment for patients with and without NHIS subscription. Other notable factors included conflicts between providers, resource constraints, and poor coordination of care at the facility. Factors which reduce delays included advocacy by providers and informal processes for prioritizing critical injuries. CONCLUSION We recommend facility-level changes including increasing equity in access to trauma and elective surgery through targeted system strengthening efforts (e.g., a scheduled back-up call system for surgeons, anesthetists, other specialists, and nurses; designated operating theatres and staff for emergencies; training of staff), policy changes to simplify the insurance renewal and subscription processes, and future research on the costs and benefits of including diagnostics, medications, and common trauma services into the NHIS benefits package.
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Affiliation(s)
- Aldina Mesic
- Department of Global Health, University of Washington, Seattle, WA, USA.
| | - Adam Gyedu
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kajal Mehta
- Department of Surgery, University of Washington, Seattle, WA, USA
| | | | - Charles Mock
- Department of Surgery, University of Washington, Seattle, WA, USA
- Harborview Injury Prevention and Research Center, Seattle, WA, USA
| | - Robert Quansah
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Peter Donkor
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Barclay Stewart
- Department of Surgery, University of Washington, Seattle, WA, USA
- Harborview Injury Prevention and Research Center, Seattle, WA, USA
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Liang OS, Yang CC. Mental health conditions and unsafe driving behaviors: A naturalistic driving study on ADHD and depression. J Safety Res 2022; 82:233-240. [PMID: 36031250 DOI: 10.1016/j.jsr.2022.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/02/2022] [Accepted: 05/26/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Road injuries remain a persistent public health concern across the world. The task of driving is complicated by mental health conditions, which may affect drivers' executive functioning and cognitive resource allocation. This study examines whether attention-deficit/hyperactivity disorder (ADHD) and depression are associated with unsafe driving behaviors. METHOD Generalized linear mixed models were employed to estimate the association of self-reported ADHD and depression with 18 unsafe driving behavior types found prior to at-fault crashes and near-crashes using a large-scale naturalistic driving dataset. Driver demographics, cognitive traits, environmental factors, and driver random effects were included to reduce confounding and biases. RESULTS Controlling for other covariates, people with self-reported ADHD were more likely to have performed improper braking or stopping (OR = 4.89, 95% CI 1.82-13.17) prior to an at-fault crash or near-crash, while those with self-reported depression did not have a significant association with any unsafe driving behavior. CONCLUSIONS After accounting for demographic, cognitive, and environmental covariates, individuals with ADHD and depression were not prone to purposefully aggressive or reckless driving. Instead, drivers with self-reported ADHD may unintentionally execute unsafe driving behaviors in particular driving scenarios that require a high level of cognitive judgment. PRACTICAL APPLICATIONS These findings can inform the curriculum design of driver's education programs that help learners with mental health conditions gain practice in certain road scenarios, for example, more practice on preemptively reducing speed instead of making sudden brakes and smooth turning on curved roads for students with ADHD. Furthermore, specific advanced driver assistance systems may prove particularly helpful for drivers with ADHD, such as detection of leading objects and curve speed warning.
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Affiliation(s)
- Ou Stella Liang
- College of Computing and Informatics, Drexel University, Philadelphia, PA 19104, United States
| | - Christopher C Yang
- College of Computing and Informatics, Drexel University, Philadelphia, PA 19104, United States.
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Allel K, Hajizadeh M, Kiadaliri A. The gap in life expectancy and lifespan inequality between Iran and neighbour countries: the contributions of avoidable causes of death. Int J Equity Health 2022; 21:81. [PMID: 35676694 PMCID: PMC9175322 DOI: 10.1186/s12939-022-01683-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 06/02/2022] [Indexed: 11/18/2022] Open
Abstract
Background Healthcare system and intersectoral public health policies play a crucial role in improving population health and reducing health inequalities. This study aimed to quantify their impact, operationalized as avoidable deaths, on the gap in life expectancy (LE) and lifespan inequality (LI) between Iran and three neighbour countries viz., Turkey, Qatar, and Kuwait in 2015–2016. Methods Annual data on population and causes of deaths by age and sex for Iran and three neighbour countries were obtained from the World Health Organization mortality database for the period 2015–2016. A recently developed list by the OECD/Eurostat was used to identify avoidable causes of death (with an upper age limit of 75). The cross-country gaps in LE and LI (measured by standard deviation) were decomposed by age and cause of death using a continuous-change model. Results Iranian males and females had the second lowest and lowest LE, respectively, compared with their counterparts in the neighbour countries. On the other hand, the highest LIs in both sexes (by 2.3 to 4.5 years in males and 1.1 to 3.3 years in females) were observed in Iran. Avoidable causes contributed substantially to the LE and LI gap in both sexes with injuries and maternal/infant mortality represented the greatest contributions to the disadvantages in Iranian males and females, respectively. Conclusions Higher mortality rates in young Iranians led to a double burden of inequality –shorter LE and greater uncertainty at timing of death. Strengthening intersectoral public health policies and healthcare quality targeted at averting premature deaths, especially from injuries among younger people, can mitigate this double burden. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-022-01683-8.
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Mishra R, Galwankar S, Konar S, Shrivastava A, Raj S, Choksey P, Mishra B, Agrawal A. Obesity as a predictor of outcome following traumatic brain injury: A systematic review and meta-analysis. Clin Neurol Neurosurg 2022; 217:107260. [DOI: 10.1016/j.clineuro.2022.107260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/25/2022] [Accepted: 04/06/2022] [Indexed: 11/25/2022]
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Elphinston RA, Vaezipour A, Fowler JA, Russell TG, Sterling M. Psychological therapy using virtual reality for treatment of driving phobia: a systematic review. Disabil Rehabil 2022; 45:1582-1594. [PMID: 35532316 DOI: 10.1080/09638288.2022.2069293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Driving phobia is prevalent in injured individuals following motor vehicle crashes (MVCs). The evidence for virtual reality (VR) based psychological treatments for driving phobia is unknown. This systematic review synthesized the available evidence on the effectiveness, feasibility, and user experience of psychological treatments for driving phobia using VR. METHODS Three databases (PsycINFO, SCOPUS, and PubMed) were searched. Eligibility criteria included adults with clinical or sub-clinical levels of driving phobia manifesting as part of an anxiety disorder or post-traumatic stress disorder (PTSD). Primary outcomes were driving-related anxiety/fear or avoidance, PTSD symptoms and driving frequency/intensity, as well as treatment feasibility including recruitment, treatment completion and retention rates, user experience and immersion/presence in the VR program. Secondary outcomes were other health outcomes (e.g., depression) and VR technological features. RESULTS The 14 included studies were of low methodological quality. Clinical and methodological heterogeneity prevented quantitative pooling of data. The evidence provided in this review is limited by trials with small sample sizes, and lack of diagnostic clarity, controlled designs, and long-term assessment. The evidence did suggest that VR-based psychological interventions could be feasible and acceptable in this population. CONCLUSIONS For VR-based psychological interventions to be recommended for driving phobia, more high-quality trials are needed. Implications for rehabilitationVirtual reality (VR) based psychological treatments may be feasible and acceptable to patients with driving phobia.There is potential to increase accessibility to psychological therapies in patients with driving phobia following motor vehicle crashes through the use of digital psychiatry such as VR.
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Affiliation(s)
- Rachel A Elphinston
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia.,National Health and Medical Research Council Centre for Research Excellence in Road Traffic Injury Recovery, The University of Queensland, Brisbane, Australia.,School of Psychology, The University of Queensland, Brisbane, Australia
| | - Atiyeh Vaezipour
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
| | - James A Fowler
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
| | - Trevor G Russell
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
| | - Michele Sterling
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia.,National Health and Medical Research Council Centre for Research Excellence in Road Traffic Injury Recovery, The University of Queensland, Brisbane, Australia
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Crilly J, Bartlett D, Sladdin I, Pellatt R, Young JT, Ham W, Porter L. Patient profile and outcomes of traumatic injury: The impact of mode of arrival to the emergency department. Collegian 2022. [DOI: 10.1016/j.colegn.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Oviedo-Trespalacios O, Newton JDA, Demant D, Phillips JG, Struckman-Johnson C. Understanding sexual activity while driving as a form of distracted driving. Accid Anal Prev 2022; 169:106621. [PMID: 35276568 DOI: 10.1016/j.aap.2022.106621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/07/2021] [Accepted: 02/16/2022] [Indexed: 06/14/2023]
Abstract
Sexual activity while driving has been reported in emerging research. Sexual activity while driving is a form of distracted driving because it includes an individual (the driver) who deviates resources from the primary task (driving) towards a secondary task (sexual activity). However, most of our current knowledge about the range of sexual activities while driving is based on self-reported data or media reports. Thus, an in-depth understanding of sexual activities while driving and their interactions with non-sexual driving behaviours and vehicle control is missing. Additionally, there is limited information on the context of where sexual activities while driving occurs and the influence of factors such as the environment, the vehicle, interactions with other road users, and other in-vehicle distractions. To cover this gap, a content analysis of sexually explicit media (SEM) was conducted on a sample of 270 videos depicting real driving. We conducted descriptive analyses and used decision tree analysis to explore the association between sexual activities while driving and their interactions with non-sexual driving behaviours and vehicle control. The videos portrayed a naturalistic driving situation of a driver of a moving vehicle engaging in sexual activity. The results show that when engaging in sexual activity, drivers do not present safe vehicle control. Sexual activity imposes additional cognitive, physical, and visual demands on the driver, thereby decreasing safety. Similar to other distractions, drivers engaging in sexual activity while driving appear to mitigate risks. Concerning the potential for legal sanctions, it appears that drivers may attempt to conceal sexual activity by reducing their visible nudity and minimising interactions with other road users. Finally, mobile phones and cameras appear to interact with sexual activities while driving, by imposing potential restrictions on the range of sexual activities. Implications for policymakers and practitioners are discussed.
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Affiliation(s)
- Oscar Oviedo-Trespalacios
- Centre for Accident Research & Road Safety-Queensland (CARRS-Q), Queensland University of Technology (QUT), Kelvin Grove, QLD, Australia; Centre for Future Mobility, Queensland University of Technology (QUT), Kelvin Grove, QLD, Australia.
| | | | - Daniel Demant
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia; School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Kelvin Grove, QLD, Australia
| | - James G Phillips
- Psychology Department, Auckland University of Technology, Auckland, New Zealand
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Hernández-Becerril Z, Orozco R, Borges G. Road traffic injuries and substance use in Latin America: A systematic review. Traffic Inj Prev 2022; 23:209-214. [PMID: 35333682 DOI: 10.1080/15389588.2022.2051018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 02/19/2022] [Accepted: 03/04/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The aim of the study is to identify and report the epidemiological patterns of substance use on fatal and non-fatal road traffic injuries (RTIs) in Latin America. METHODS A systematic review identified all published studies from January 2010 through October 2020. Twenty-eight studies were included from PubMed and SciELO databases. The Newcastle-Ottawa scale was used to assess the methodological quality of the studies. RESULTS The prevalence of alcohol consumption in fatal RTIs in studies where 100% of the target population were tested varies from 15.3% up to 55% in Brazil; with respect to non-fatal RTIs, it varies from 9.1% in car drivers in Brazil to 24.1% in emergency patients in Argentina. The most studied drug other than alcohol was cannabis, present in 6.5% up to 20.8% of non-fatal RTIs cases, but lower rates of testing for drugs was reported. Few studies reported epidemiological association measures. CONCLUSIONS This article shows that scientific production on substance use and RTIs in the region is limited and reports the prevalence of substance use, with few estimates of the relative risk of drug use and RTIs.
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Affiliation(s)
- Zaide Hernández-Becerril
- Nursing Department, Hospital General Regional No. 2 "Mexican Institute of Social Security", Mexico City, Mexico
- Doctorate Program in Medical, Odontology and Health Sciences of the National Autonomous, University of Mexico, Mexico City, Mexico
| | - Ricardo Orozco
- Directorate of Epidemiological and Psychosocial Research, National Institute of Psychiatry "Ramón de la Fuente Muñiz", Mexico City, Mexico
| | - Guilherme Borges
- Directorate of Epidemiological and Psychosocial Research, National Institute of Psychiatry "Ramón de la Fuente Muñiz", Mexico City, Mexico
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Job RFS, Truong J, Sakashita C. The Ultimate Safe System: Redefining the Safe System Approach for Road Safety. Sustainability 2022; 14:2978. [DOI: 10.3390/su14052978] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Safe System approach to road safety has been adopted in many countries, but it has been adopted pervasively to a substantially constrained extent. This paper argues that effective adoption is hampered by two weaknesses in strategies for the implementation of Safe System: (1) interpretations of the shared responsibility principle and (2) Safe System adoption presented as simply requiring the use of multiple pillars of action. The typical description of shared responsibility includes responsibility by road users to obey the rules. This absolves accountability for road safety by the system owners and operators, facilitating victim blaming and reliance on road users who are acknowledged to be fallible. Thus, the system cannot be fully safe, and the vision of zero road trauma cannot be achieved. The extent to which road users are responsible for road safety via their actions is precisely the extent to which those responsible for the system have failed to deliver a safe road system. The assessment of road safety plans as Safe System because it includes multiple pillars of action fails to distinguish a system approach from a Safe System approach. Through these inclusions and interpretations, road safety advocates inadvertently obviate the responsibility of system owners and operators to provide a safe road system and prevent the achievement of zero road trauma, which nonetheless remains the vision described in Safe System strategies and plans. The Ultimate Safe System approach is proposed with a definition that genuinely drives the delivery of a truly Safe System and thus zero road trauma. Practical implications are considered.
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Gutierrez H, Mitra S, Neki K, Mbugua LW, Balasubramaniyan R, Winer M, Roberts J, Vos T, Hamilton E, Naghavi M, Harrison JE, Job RFS, Bhalla K. Comparing estimates of road traffic deaths and non-fatal road traffic injuries in Cambodia. Inj Prev 2022; 28:340-346. [PMID: 35149595 DOI: 10.1136/injuryprev-2021-044504] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/22/2022] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Timely, accurate and detailed information about traffic injuries are essential for managing national road safety programmes. However, there is considerable under-reporting in official statistics of many low and middle-income countries (LMICs) and large discrepancies between estimates from the Global Burden of Disease (GBD) study and WHO's Global Health Estimates (GHE). We compared all sources of epidemiological information on traffic injuries in Cambodia to guide efforts to improve traffic injury statistics. METHODS We estimated the incidence of traffic deaths and injuries and household ownership of motor vehicles in Cambodia from nationally representative surveys and censuses. We compared findings with GDB and GHE estimates. RESULTS We identified seven sources for estimating traffic deaths and three for non-fatal injuries that are not included as data sources in GBD and GHE models. These sources and models suggest a fairly consistent estimate of approximately 3100 deaths annually, about 50% higher than official statistics, likely because most hospital deaths are not recorded. Surveys strongly suggest that the vehicle fleet is dominated by motorcycles, which is not consistent with GBD estimates that suggest similar numbers of motorcyclist and vehicle occupant deaths. Estimates of non-fatal injuries from health surveys were about 7.5 times official statistics and 1.5 times GBD estimates. CONCLUSION Including local epidemiological data sources from LMICs can help reduce uncertainty in estimates from global statistical models and build trust in estimates among local stakeholders. Such analysis should be used as a benchmark to assess and strengthen the completeness of reporting of the national surveillance system.
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Affiliation(s)
- Hialy Gutierrez
- Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | - Sudeshna Mitra
- Global Road Safety Facility, World Bank, Washington, DC, USA
| | - Kazuyuki Neki
- Global Road Safety Facility, World Bank, Washington, DC, USA
| | | | | | - Mercer Winer
- Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | - Jaeda Roberts
- Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Erin Hamilton
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - James E Harrison
- Research Center for Injury Studies, Flinders University, Bedford Park, South Australia, Australia
| | - R F Soames Job
- Global Road Safety Facility, World Bank, Washington, DC, USA
| | - Kavi Bhalla
- Public Health Sciences, University of Chicago, Chicago, Illinois, USA
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Stimpson JP, Becker AW, Shea L, Wilson FA. Association of health insurance coverage and probability of dying in an emergency department or hospital from a motor vehicle traffic injury. J Am Coll Emerg Physicians Open 2022; 3:e12652. [PMID: 35128533 PMCID: PMC8795214 DOI: 10.1002/emp2.12652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 12/03/2021] [Accepted: 12/28/2021] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Describe the association of health insurance coverage with the odds of mortality in an emergency department (ED) or hospital for adult victims of a motor vehicle crash. METHODS This cross-sectional study pooled and averaged 6 years of data, 2009-2014, from the Nationwide Emergency Department Sample (NEDS). Our analysis was restricted to patients 20-85 years old that were treated in an ED for an injury sustained from a motor vehicle traffic crash (N = 2,203,407 average annual hospital discharges). The outcome variables were whether the motor vehicle crash victim died in the ED or hospital. The predictor variable was health insurance status that was measured as uninsured, Medicare, Medicaid, private insurance, and other health insurance. RESULTS Most patients that died had some form of health insurance with less than a quarter classified as uninsured (23%). Nearly half of the patients that died had private insurance (48%) followed by Medicare (13%), Medicaid (9%), and other insurance (8%). Compared to the uninsured, the multivariate adjusted odds ratios (ORs) for death were significantly (P < 0.001) lower for Medicare (OR = 0.83, 95% confidence interval [CI] = 0.76-0.92), Medicaid (OR = 0.76, 95% CI = 0.69-0.84), private insurance (OR = 0.63, 95% CI = 0.58-0.68), and other insurance (OR = O.61, 95% CI = 0.54-0.70). CONCLUSION After accounting for hospital and patient characteristics, lack of health insurance was associated with a higher likelihood of death for patients admitted to an ED or hospital for injuries sustained from a motor vehicle crash.
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Affiliation(s)
- Jim P. Stimpson
- Drexel University, Dornsife School of Public HealthPhiladelphiaPennsylvaniaUSA
| | - Alec W. Becker
- Drexel University, A.J. Drexel Autism InstitutePhiladelphiaPennsylvaniaUSA
| | - Lindsay Shea
- Drexel University, Dornsife School of Public HealthPhiladelphiaPennsylvaniaUSA
- Drexel University, A.J. Drexel Autism InstitutePhiladelphiaPennsylvaniaUSA
| | - Fernando A. Wilson
- University of Utah, Matheson Center for Health Care StudiesSalt Lake CityUtahUSA
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Malta DC, de Morais OL, Cardoso LSDM, Veloso GA, de Andrade FMD, Vasconcelos AMN, de Lima CM, Ribeiro ALP, Naghavi M. Road traffic injuries and deaths and the achievement of UN Sustainable Development Goals in Brazil: results from the Global Burden of Disease Study, 1990 to 2019. Rev Soc Bras Med Trop 2022; 55:e0261. [PMID: 35107524 PMCID: PMC9038143 DOI: 10.1590/0037-8682-0261-2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/29/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Brazil ranks 5th in the number of deaths due to road injuries. This study aimed to analyze mortality and disabilities resulting from road injuries in Brazil, and to assess the Sustainable Development Goals (SDG) target of reducing deaths due to road injuries by 50% by 2030. METHODS This descriptive and exploratory study used the estimates from the Global Burden of Disease 2019: indicators of mortality, premature deaths, and disabilities according to sex, age group, and type of transport for 1990, 2015, and 2019. Time trends in mortality rates from 1990 to 2019 were assessed, and a projection for 2030 was calculated, applying a linear regression model. RESULTS Deaths due to road injuries were 44,236 in 1990, and 44,529 in 2019, representing a 43% reduction in mortality rates. The highest rates were in the North, Northeast, and Midwest regions of Brazil, in males and young adults. A 77% reduction was observed in mortality rates for pedestrians and an increase of 53% for motorcyclists and of 54% for cyclists during the period. In terms of motorcycle road injuries, the mortality rate for men increased from 7.3/100,000 (1990) to 11.7/100,000 inhabitants (2019). The rates of premature deaths and disabilities were also higher for men when compared to women. Amputations, fractures, spinal cord injuries, and head trauma were the main types of road injuries. The projections for 2030 show that Brazil might not reach the SDG target. CONCLUSIONS Despite the decline in mortality rates, the 2030 Agenda's target might not be achieved.
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Affiliation(s)
- Deborah Carvalho Malta
- Universidade Federal de Minas Gerais, Departamento de Enfermagem
Materno Infantil e Saúde Pública, Belo Horizonte, MG, Brasil
| | | | | | - Guilherme Augusto Veloso
- Universidade Federal de Minas Gerais, Departamento de Estatística,
Programa de Pós-Graduação em Estatística, Belo Horizonte, MG, Brasil
| | - Fabiana Martins Dias de Andrade
- Universidade Federal de Minas Gerais, Faculdade de Medicina,
Programa de Pós-Graduação em Saúde Pública, Belo Horizonte, MG, Brasil
| | | | | | - Antonio Luiz Pinho Ribeiro
- Universidade Federal de Minas Gerais, Faculdade de Medicina,
Hospital das Clínicas, Belo Horizonte, MG, Brasil
| | - Mohsen Naghavi
- University of Washington, Institute for Health Metrics and
Evaluation, Seattle, Washington, USA
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Yasin YJ, Grivna M, Abu-Zidan FM. Motorized 2-3 wheelers death rates over a decade: a global study. World J Emerg Surg 2022; 17:7. [PMID: 35081985 DOI: 10.1186/s13017-022-00412-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Motorized 2-3-wheelers-related death is high due to the exposed body of the driver/passenger and the high speed. The United Nation (UN) Decade of Action for road safety aimed to reduce road traffic deaths by 50% by the year 2020. We aimed to study the factors affecting the death rates of motorized 2-3 wheelers injured victims and whether the reduction in the death rates has met the UN target. METHODS Data were retrieved from the WHO Global Status Reports on Road Safety published over 2009 to 2018 which covered the years of 2007 to 2016. Studied variables included motorized 2-3 wheelers death rates, percentage of helmet-wearing rate, helmet law enforcement, speed law enforcement, gross national income per capita, vehicles/person ratio, and motorized 2-3 wheelers/person ratio. A mixed linear model was used to define factors affecting the change of motorized 2-3 wheelers death rates over time. RESULTS The global mean motorized 2-3 wheelers death rates increased from 2.37/100,000 population to 3.23/100,000 population over the studied decade (a relative ratio of 1.36) which was not statistically significant. Factors that affected mortality included GNI (p = 0.025), motorized 2-3 wheelers per person ratio (p < 0.0001), percentage of helmet wearing rate (p = 0.046), and the interaction between vehicle/person ratio and motorized 2-3 wheelers/person ratio (p = 0.016). There was a significant increase in the death rates over time in the low-income countries (a relative ratio of 2.52, p = 0.019, Friedman test), and middle-income countries (a relative ratio of 1.46, p < 0.0001, Friedman test), compared with a significant decrease in the high-income countries (a relative ratio of 0.72, p < 0.0001, Friedman test). CONCLUSIONS Global mortality of motorized 2-3 wheelers has increased by a relative ratio of 1.36 over a recent decade. The UN target of reducing death was not met. The increase was related to the increase in motorized 2-3 wheelers per person ratio and economic inequity which has to be addressed globally. The economic global gap significantly impacts the mortality rates of motorized 2-3 wheelers.
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Borges G, García-Pacheco JÁ, Familiar-Lopez I. Global estimates of the attributable risk of alcohol consumption on road injuries. Alcohol Clin Exp Res 2021; 45:2080-2089. [PMID: 34748239 DOI: 10.1111/acer.14689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/19/2021] [Accepted: 07/29/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Alcohol consumption is one of the main risk factors for death by road injuries, but little is known about the global distribution of the population-attributable risk (PAR) of alcohol use for death by road injuries. METHODS We used publicly available data from the 2019 Global Burden of Disease Study (GBD) to estimate the PAR of alcohol use for 5 types of road injury, globally and individually for available countries, by socio-demographic index (SDI), and by age, sex, and year from 1990 to 2019. RESULTS 6.6% of all road injuries in 2019 were attributable to alcohol consumption, with large variations worldwide; the highest burden was in Europe and among countries classified in the high-middle SDI. PAR was higher in men than in women, and among younger individuals. Important variations in PAR of alcohol were also observed by road injury type, with motorcyclist road injuries having the highest PAR. Overall, PAR showed a small increase during 1990-2019; younger (<39 years old) men showed an increasing trend during this period, while older women had a decreasing trend in PAR. CONCLUSIONS PAR for alcohol and road injuries is not homogenous. Large PAR for alcohol and road deaths was found in Europe, among men, young adults, and motorcyclists. These results could help public health agencies, law enforcement, and the public guide efforts to reduce these deaths.
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Affiliation(s)
- Guilherme Borges
- Instituto Nacional de Psiquiatría Ramon de la Fuente Muñiz, Ciudad de México, Mexico
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Giummarra MJ, Xu R, Guo Y, Dipnall JF, Ponsford J, Cameron PA, Ameratunga S, Gabbe BJ. Driver, Collision and Meteorological Characteristics of Motor Vehicle Collisions among Road Trauma Survivors. Int J Environ Res Public Health 2021; 18:ijerph182111380. [PMID: 34769922 PMCID: PMC8583338 DOI: 10.3390/ijerph182111380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 11/22/2022]
Abstract
Road trauma remains a significant public health problem. We aimed to identify sub-groups of motor vehicle collisions in Victoria, Australia, and the association between collision characteristics and outcomes up to 24 months post-injury. Data were extracted from the Victorian State Trauma Registry for injured drivers aged ≥16 years, from 2010 to 2016, with a compensation claim who survived ≥12 months post-injury. People with intentional or severe head injury were excluded, resulting in 2735 cases. Latent class analysis was used to identify collision classes for driver fault and blood alcohol concentration (BAC), day and time of collision, weather conditions, single vs. multi-vehicle and regional vs. metropolitan injury location. Five classes were identified: (1) daytime multi-vehicle collisions, no other at fault; (2) daytime single-vehicle predominantly weekday collisions; (3) evening single-vehicle collisions, no other at fault, 36% with BAC ≥ 0.05; (4) sunrise or sunset weekday collisions; and (5) dusk and evening multi-vehicle in metropolitan areas with BAC < 0.05. Mixed linear and logistic regression analyses examined associations between collision class and return to work, health (EQ-5D-3L summary score) and independent function Glasgow Outcome Scale - Extended at 6, 12 and 24 months. After adjusting for demographic, health and injury characteristics, collision class was not associated with outcomes. Rather, risk of poor outcomes was associated with age, sex and socioeconomic disadvantage, education, pre-injury health and injury severity. People at risk of poor recovery may be identified from factors available during the hospital admission and may benefit from clinical assessment and targeted referrals and treatments.
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Affiliation(s)
- Melita J. Giummarra
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (R.X.); (Y.G.); (J.F.D.); (P.A.C.); (B.J.G.)
- Caulfield Pain Management and Research Centre, Caulfield Hospital, Caulfield, VIC 3162, Australia
- Correspondence: ; Tel.: +61-4-3964-1211
| | - Rongbin Xu
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (R.X.); (Y.G.); (J.F.D.); (P.A.C.); (B.J.G.)
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (R.X.); (Y.G.); (J.F.D.); (P.A.C.); (B.J.G.)
| | - Joanna F. Dipnall
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (R.X.); (Y.G.); (J.F.D.); (P.A.C.); (B.J.G.)
- Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC 3220, Australia
| | - Jennie Ponsford
- School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia;
- Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Richmond, VIC 3121, Australia
| | - Peter A. Cameron
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (R.X.); (Y.G.); (J.F.D.); (P.A.C.); (B.J.G.)
| | - Shanthi Ameratunga
- School of Population Health, University of Auckland, Auckland 1010, New Zealand;
- Population Health Directorate, Counties Manukau District Health Board, South Auckland 2104, New Zealand
| | - Belinda J. Gabbe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (R.X.); (Y.G.); (J.F.D.); (P.A.C.); (B.J.G.)
- Health Data Research UK, Swansea University Medical School, Singleton Park, Swansea University, Swansea SA2 8PP, UK
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Algahtany MA. Investigating the Association between Orthopedic Fractures and Head Injury due to Road Traffic Accidents. Appl Bionics Biomech 2021; 2021:2430090. [PMID: 34745344 PMCID: PMC8566076 DOI: 10.1155/2021/2430090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/07/2021] [Accepted: 10/18/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Traumatic head injury (THI) due to road traffic accidents (RTAs) is a global health problem. Studies exploring the association between RTA-related THI and concurrent orthopedic fractures are lacking. We aim to provide a detailed analysis of this association and its impact on inhospital outcomes. METHODS Retrospective analysis of RTA-related THI associated with orthopedic fractures admitted to a large tertiary center, Southwest, Saudi Arabia, over ten years. Descriptive statistics for participant demographics and clinical outcomes were represented by percentages. The associations between head injury diagnosis or orthopedic fractures region and patient demographics are analyzed using the Chi-square test. Post hoc analysis for the significant Chi-square values was carried out by calculating the significant adjusted residuals. Adjust p value was obtained by using the Benjamini-Hochberg procedure to control for multiplicity testing. A p value less than 0.05 was considered statistically significant. RESULTS Concurrent orthopedic fractures are present in one-tenth of RTA-related THI. The cohort was dominated by young males, with 46.5% of the population between 18 and 29 years old. There was a significant association between the head injury diagnosis and the region of orthopedic fracture (p = 0.028). The type of head injury had significant associations with mortality and duration of hospital stay (p = 0.039 and p = 0.037, respectively). The region of orthopedic fracture significantly (p = 0.018) affected the duration of hospital stay, with fractures in the clavicle/shoulder region significantly (p = 0.035) having a short course of hospital admission. CONCLUSION Orthopedic fractures concomitant with RTA-related THI are common. The associations between the two injuries tend to happen in specific patterns. The inhospital stay duration and mortality significantly correlated with the site of the head or orthopedic injury. Knowledge of these patterns improves the care of THI victims, triaging, and resource allocations.
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Affiliation(s)
- Mubarak Ali Algahtany
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Khalid University, Abha, Saudi Arabia
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Soffian SSS, Nawi AM, Hod R, Chan HK, Hassan MRA. Area-Level Determinants in Colorectal Cancer Spatial Clustering Studies: A Systematic Review. Int J Environ Res Public Health 2021; 18:10486. [PMID: 34639786 DOI: 10.3390/ijerph181910486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/01/2021] [Accepted: 10/03/2021] [Indexed: 12/12/2022]
Abstract
The increasing pattern of colorectal cancer (CRC) in specific geographic region, compounded by interaction of multifactorial determinants, showed the tendency to cluster. The review aimed to identify and synthesize available evidence on clustering patterns of CRC incidence, specifically related to the associated determinants. Articles were systematically searched from four databases, Scopus, Web of Science, PubMed, and EBSCOHost. The approach for identification of the final articles follows PRISMA guidelines. Selected full-text articles were published between 2016 and 2021 of English language and spatial studies focusing on CRC cluster identification. Articles of systematic reviews, conference proceedings, book chapters, and reports were excluded. Of the final 12 articles, data on the spatial statistics used and associated factors were extracted. Identified factors linked with CRC cluster were further classified into ecology (health care accessibility, urbanicity, dirty streets, tree coverage), biology (age, sex, ethnicity, overweight and obesity, daily consumption of milk and fruit), and social determinants (median income level, smoking status, health cost, employment status, housing violations, and domestic violence). Future spatial studies that incorporate physical environment related to CRC cluster and the potential interaction between the ecology, biology and social determinants are warranted to provide more insights to the complex mechanism of CRC cluster pattern.
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Burzyńska M, Pikala M. Decreasing Trends in Road Traffic Mortality in Poland: A Twenty-Year Analysis. Int J Environ Res Public Health 2021; 18:ijerph181910411. [PMID: 34639711 PMCID: PMC8508264 DOI: 10.3390/ijerph181910411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 11/16/2022]
Abstract
The aim of the study was to assess mortality trends due to road traffic accidents in Poland between 1999 and 2018. The study material was a database including 7,582,319 death certificates of all inhabitants of Poland who died in the analyzed period (104,652 people died of transport accidents). Crude deaths rates (CDR), standardized death rates (SDR) and joinpoint models were used. Annual percentage change (APC) for each segment of broken lines and average annual percentage change (AAPC) for the whole study period were calculated. CDR decreased from 19.7 per 100,000 population in 1999 to 9.6 per 100,000 population in 2018; APC was -4.1% (p < 0.05) while SDR decreased from 20.9 to 10.9 per 100,000; APC was -4.1% (p < 0.05). Large differences in traffic accident-related mortality were observed between men and women. An analysis by gender and age shows that the decline in the number of deaths due to traffic accidents has been slowed down in the oldest age group, 65+, in both males and females. There is a need for in-depth analyses aimed at introducing effective preventive solutions in the field of road traffic safety in Poland. Legal regulations should particularly refer to the most endangered groups of road users.
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Piyasena P, Olvera-Herrera VO, Chan VF, Clarke M, Wright DM, MacKenzie G, Virgili G, Congdon N. Vision impairment and traffic safety outcomes in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Glob Health 2021; 9:e1411-e1422. [PMID: 34411516 DOI: 10.1016/s2214-109x(21)00303-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/01/2021] [Accepted: 06/21/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Road traffic injuries are a major public health concern and their prevention requires concerted efforts. We aimed to systematically analyse the current evidence to establish whether any aspects of vision, and particularly interventions to improve vision function, are associated with traffic safety outcomes in low-income and middle-income countries (LMICs). METHODS We did a systematic review and meta-analysis to assess the association between poor vision and traffic safety outcomes. We searched MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials in the Cochrane Library from database inception to April 2, 2020. We included any interventional or observational studies assessing whether vision is associated with traffic safety outcomes, studies describing prevalence of poor vision among drivers, and adherence to licensure regulations. We excluded studies done in high-income countries. We did a meta-analysis to explore the associations between vision function and traffic safety outcomes and a narrative synthesis to describe the prevalence of vision disorders and adherence to licensure requirements. We used random-effects models with residual maximum likelihood method. The systematic review protocol was registered on PROSPERO, CRD-42020180505. FINDINGS We identified 49 (1·8%) eligible articles of 2653 assessed and included 29 (59·2%) in the various data syntheses. 15 394 participants (mean sample size n=530 [SD 824]; mean age of 39·3 years [SD 9·65]; 1167 [7·6%] of 15 279 female) were included. The prevalence of vision impairment among road users ranged from 1·2% to 26·4% (26 studies), colour vision defects from 0·5% to 17·1% (15 studies), and visual field defects from 2·0% to 37·3% (ten studies). A substantial proportion (range 10·6-85·4%) received licences without undergoing mandatory vision testing. The meta-analysis revealed a 46% greater risk of having a road traffic crash among those with central acuity visual impairment (risk ratio [RR] 1·46 [95% CI 1·20-1·78]; p=0·0002, 13 studies) and a greater risk among those with defects in colour vision (RR 1·36 [1·01-1·82]; p=0·041, seven studies) or the visual field (RR 1·36 [1·25-1·48]; p<0·0001, seven studies). The I2 value for overall statistical heterogeneity was 63·4%. INTERPRETATION This systematic review shows a positive association between vision impairment and traffic crashes in LMICs. Our findings provide support for mandatory vision function assessment before issuing a driving licence. FUNDING None.
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Affiliation(s)
- Prabhath Piyasena
- School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Science, Centre for Public Health, Royal Victoria Hospital, Queen's University, Belfast, UK
| | - Victoria Odette Olvera-Herrera
- School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Science, Centre for Public Health, Royal Victoria Hospital, Queen's University, Belfast, UK
| | - Ving Fai Chan
- School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Science, Centre for Public Health, Royal Victoria Hospital, Queen's University, Belfast, UK; School of Optometry, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Mike Clarke
- School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Science, Centre for Public Health, Royal Victoria Hospital, Queen's University, Belfast, UK
| | - David M Wright
- School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Science, Centre for Public Health, Royal Victoria Hospital, Queen's University, Belfast, UK
| | | | - Gianni Virgili
- School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Science, Centre for Public Health, Royal Victoria Hospital, Queen's University, Belfast, UK
| | - Nathan Congdon
- School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Science, Centre for Public Health, Royal Victoria Hospital, Queen's University, Belfast, UK; Department of Preventive Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, China; Orbis International, New York, NY, USA.
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Alghnam S, Alkelya M, Aldahnim M, Aljerian N, Albabtain I, Alsayari A, Da'ar OB, Alsheikh K, Alghamdi A. Healthcare costs of road injuries in Saudi Arabia: A quantile regression analysis. Accid Anal Prev 2021; 159:106266. [PMID: 34225170 DOI: 10.1016/j.aap.2021.106266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 05/09/2021] [Accepted: 06/16/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Road traffic injuries (RTIs) are the second leading cause of death in Saudi Arabia. Their economic burden is significant but poorly quantified, as limited literature exists locally. We aim to estimate the impact of RTIs on healthcare costs. METHODS We included all patients from the hospital's trauma registry for the year 2017 (n = 381). Due to the availability of data, the analysis focused only on direct medical costs incurred during the hospitalization period. We computed the components of hospitalization costs and evaluated the association between patient and RTI characteristics and total hospitalization costs (the average and median) using quantile and log-linear regression techniques respectively. RESULTS Patients were relatively young with an average age of 31 years (SD ± 14.6). Overall, patients treated for RTIs cost the hospital around 77,657 Saudi Riyal (SAR) on average. Pedestrian injuries incurred the highest costs. Motor vehicle injuries accounted for the highest procedure-related costs (SAR 19,537). The quantile regressions results suggest that Glasgow coma scale (GCS), admission to intensive care unit (ICU), and hospital length of stay were significantly associated with an increase in hospitalization cost. Hospital home disposition was however, associated with a decrease in cost. One additional day of stay in the hospital increases total hospitalization cost by SAR 3,508. Additionally, the log-linear showed injury severity score (ISS < 16) was associated with a 20% decrease in the geometric mean of the hospitalization costs (p < 0.001). CONCLUSIONS This study underlines the economic burden of RTIs in addition to their impact on population health. The findings may be used to inform policymakers, researchers, and the public about the increasing burden of traffic crashes in the Kingdom. Public health interventions are warranted to reduce the severity and frequency of RTIs in order to improve traffic safety and reduce associated healthcare costs.
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Affiliation(s)
- Suliman Alghnam
- Population Health Department, King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences (KSUHS), Riyadh, Saudi Arabia.
| | - Mohamed Alkelya
- The Center for Health Research Studies (CHRS), Saudi Health Council, Riyadh, Saudi Arabia.
| | - Mahdya Aldahnim
- Respiratory Care Department, Specialized Medical Center Hospital, Riyadh, Saudi Arabia
| | | | - Ibrahim Albabtain
- Department of Surgery, King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Alaa Alsayari
- The Center for Health Research Studies (CHRS), Saudi Health Council, Riyadh, Saudi Arabia.
| | - Omar B Da'ar
- College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Khalid Alsheikh
- Department of Orthopedics, King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Ali Alghamdi
- National Center for Road Safety, Riyadh, Saudi Arabia.
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Garosi VH, Tanhaie S, Chaboksavar F, Kamari T, Gheshlaghi PA, Toghroli R, Soltaninezhad S, Azizi SA, Yazdani V, Mahmoodi F. An overview of 2019 novel coronavirus COVID-19 pandemic: A review study. J Educ Health Promot 2021; 10:280. [PMID: 34485577 PMCID: PMC8395953 DOI: 10.4103/jehp.jehp_1403_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/25/2020] [Indexed: 05/07/2023]
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, was first reported in December 2019 in Wuhan, Hubei province, China. It is now known as a pandemic and a global crisis due to rapid human-to-human transmission with the vast expansion that has affected almost all countries. The primary source of the disease is still unknown, but it is possible that the virus was transmitted through bat to an intermediate host and then to humans. The main and early symptoms of COVID-19 infection are fatigue, fever, dry cough, myalgia, and dyspnea. The incubation period of the disease is about 2-14 days, which is one of the important parameters for planning to prevent disease outbreak. PT-polymerase chain reaction test is used to diagnose the disease; chest computed tomography scan, chest X-ray, blood tests, and symptoms are also very helpful in diagnosing the disease. There is a strong emphasis on controlling infections and hand hygiene to prevent the transmission of the disease. There is not enough knowledge about this disease yet, and there are no specific vaccines or medications available to prevent and treat this disease. The current review study uses articles indexed on databases of Embase, Elsevier, PubMed, and World Health Organization and Centers for Disease Control and Prevention, and keywords of coronavirus, COVID-19, acute respiratory distress syndrome and China.
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Affiliation(s)
- Vahid Hatami Garosi
- Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sepideh Tanhaie
- Department of Health Education and Promotion, School of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Fakhreddin Chaboksavar
- Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R. Iran
| | - Teymour Kamari
- Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Razie Toghroli
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Simin Soltaninezhad
- Department of Radiology, School of Medicine, Kerman University of Medical Science, Kerman, Iran
| | - Seyyed Amar Azizi
- PhD. Student of Social Welfare and Health, University of Social Welfare and Rehabilitation Sciences,Tehran, Iran
| | - Vahid Yazdani
- Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fatemeh Mahmoodi
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Dávila-Cervantes CA. Road injury burden in Mexico 1990 to 2019: Secondary data analysis from the Global Burden of Disease Study. Accid Anal Prev 2021; 160:106316. [PMID: 34332290 DOI: 10.1016/j.aap.2021.106316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 06/30/2021] [Accepted: 07/16/2021] [Indexed: 02/05/2023]
Abstract
Road injuries have been a major cause of premature mortality and disability in Mexico. The objective of this paper is to report the findings from the Global Burden of Disease study (GBD-2019) on road injuries in Mexico at a national and subnational scale from 1990 to 2019, and to assess the association between road injury burden and the socio-demographic index. Following the 2019 Global Burden of Disease study road injury mortality, premature mortality, the years lived with disability and disability-adjusted life-years (DALYs) are reported. While the number of deaths from road injuries increased between 1990 and 2019, the age-standardized mortality rates declined. Pedestrian road injuries and motor vehicle road injuries accounted for 8 of every 10 deaths from road injury in 2019. Road injury mortality and DALY rates decreased nationally, but stagnated since 2011. The road injury burden was higher for men in all age groups. Pedestrian and motor vehicle road injuries caused the highest DALY rate in both males and females. There was no significant association between the SDI and the road injury age-standardized DALY rates. This study presents a comprehensive report of road injury burden of disease in Mexico. Mexico continues to have an incomplete, fragmented and poorly enforced legislative framework, with a large diversity between its 32 states. Thus, an integrated legislative and juridical effort is needed to continue reducing the road injury disease burden, which is tailored for specific age groups, vulnerable road users and high-burden areas.
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Algahtany MA. Secular Trend, Seasonal Variation, Epidemiological Pattern, and Outcome of Traumatic Head Injuries Due to Road Traffic Accidents in Aseer, Saudi Arabia. Int J Environ Res Public Health 2021; 18:6623. [PMID: 34202974 DOI: 10.3390/ijerph18126623] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/10/2021] [Accepted: 06/17/2021] [Indexed: 11/18/2022]
Abstract
Road traffic accidents (RTAs) are a leading cause of traumatic head injury (THI) and are regarded as a public health problem in Saudi Arabia. This hospital-based retrospective study aims to provide data on the frequency, type, and distribution of RTA-related THIs over the past decade; demonstrate their time trend and seasonality; and decipher age and sex differences in RTA-related THIs and their outcome. The results showed a decline in the number of RTA-related THIs between 2010 and 2019. The patients had a mean age of 26.16 ± 16.27 years, and the male-to-female ratio was 10.8:1. Head injury with multiple lesions was the most common diagnosis, followed by cerebral contusion and skull fracture (32.1%, 12.9%, and 11.2%, respectively). Subdural hematoma (SDH) and skull fracture were significantly more common in patients aged ≥60 years (standard residual > 1.96), and significantly less common in those aged ≤17 years (standard residual < 1.96), compared to other age groups. Males experienced significantly more SDHs than females (standard residual = −2.8, p = 0.029). The length of hospital stay was positively correlated with age (Spearman’s rho = 0.057, p = 0.046). No seasonal variation was found.
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Jakovljevic M, Sharma T, Kumagai N, Ogura S. Editorial: NCDs - Core Challenge of Modern Day Health Care Establishments. Front Public Health 2021; 9:692926. [PMID: 34222188 PMCID: PMC8249752 DOI: 10.3389/fpubh.2021.692926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/26/2021] [Indexed: 01/20/2023] Open
Affiliation(s)
- Mihajlo Jakovljevic
- Institute of Comparative Economic Studies, Hosei University, Tokyo, Japan.,Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, Serbia
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Bahardoust M, Karimi Behnagh A, Bagherifard A, Khodabandeh M, Emami SA, Ghasemi Assl S, Najd Mazhar F. Comparing the Severity of Injury and Trauma Pattern between Scooter and Street Motorcycle Riders; a Prospective Cohort Study. Arch Acad Emerg Med 2021; 9:e43. [PMID: 34223188 PMCID: PMC8221545 DOI: 10.22037/aaem.v9i1.1229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: The popularity of motorcycle riding in Iran is increasing. However, there is a lack of information about the safety of different motorcycle types. This study aimed to compare the severity of injury and trauma pattern between scooter (vespa) and street (standard) motorcycle riders. Method: In a prospective cohort study, a comparison of demographics, injury severity, trauma pattern, and clinical characteristics between 324 riders (162 Vespa and 162 standard motorcycles) admitted to emergency departments was undertaken. The risk factors associated with severe injuries in the two groups were also determined. An emergency medicine specialist determined the severity of trauma based on the abbreviated injury scale (AIS). Results: The Odds Ratio (OR) of severe injuries was significantly higher in the standard motorcycle riders’ group (OR: 3.09; 95% CI: 1.9-4.21; p: 0.013). The frequency of lower extremity fractures was significantly lower in the Vespa group (OR: 4.11; 95% CI: 2.01-6.25; p = 0.012). The frequency of admission to the intensive care unit was significantly higher in the standard motorbike riders’ group (OR: 1.64; 95% CI: 1.11-2.51; p = 0.033). The multivariate analysis indicated that motorcycle type, the speed at the time of the accident, use of helmet, and age of riders are the most important predictors of trauma severity in riders (p<0.05). Conclusion: The pattern of injury varies between standard and Vespa motorcycles. The standard motorcycle riders were prone to a higher risk of adverse outcomes such as severe injuries. Due to the particular structure of scooters, the rate of lower limb injuries was significantly lower than standard motorcycles.
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Affiliation(s)
- Mansour Bahardoust
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Abolfazl Bagherifard
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Khodabandeh
- Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, Iran University of Medical Sciences
| | - Seyed Ali Emami
- Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, Iran University of Medical Sciences
| | | | - Farid Najd Mazhar
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
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Jesus TS, Arango-Lasprilla JC, Kumar Kamalakannan S, Landry MD. Growing physical rehabilitation needs in resource-poor world regions: secondary, cross-regional analysis with data from the global burden of disease 2017. Disabil Rehabil 2021; 44:5429-5439. [PMID: 34086516 DOI: 10.1080/09638288.2021.1933619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE This paper aims to analyze the levels and trajectories of physical rehabilitation needs across five resource-poor world regions, against global and key country-specific benchmarks. MATERIALS AND METHODS This comparative, secondary cross-region analysis uses data from the Global Burden of Diseases study 2017 [1990-2017], specifically varied metrics of the Years Lived with Disability (YLD) measure from the health conditions likely benefiting from physical rehabilitation. RESULTS All the resource-poor world regions had significant increases (p < 0.01) in the absolute, relative, and percentage of physical rehabilitation needs [1990-2017]. Nonetheless, The Asia-Pacific region stood out with the greatest YLD Rates (i.e., per population size) in 2017, the greatest growth in YLD Rates since 1990 (38%), and an exponential growth in the rehabilitation-sensitive YLD Rates. The Asia-Pacific region also had the greatest portion of their YLDs coming from rehabilitation-sensitive conditions (72% in 2017), closely followed by the Latin America & Caribbean (67%). Nonetheless, in South Asia and Sub-Saharan Africa, we observed the greatest percent increases in the portion of physical rehabilitation needs among all YLDs, out of lower initial values. CONCLUSIONS An overall growth but differential patterns were observed in the evolution of physical rehabilitation needs across the resource-poor world regions.IMPLICATIONS FOR REHABILITATIONAsia-Pacific and Latin America & Caribbean regions had over than two-thirds of their non-fatal health loss arising from conditions sensitive to physical rehabilitation, and important growths in rehabilitation need indicators have been observed also for South Asia and Sub-Saharan Africa.The scale-up and strengthening of rehabilitation services and resources should be informed by needs-based data.The needs-based data from this study can inform trans-national developments and the planning of rehabilitation resources, inclusively at the world-region level.
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Affiliation(s)
- Tiago S Jesus
- Global Healthand Tropical Medicine and WHO Collaborating Centre for Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Lisbon, Portugal.,Department of Occupational Therapy, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
| | - Juan Carlos Arango-Lasprilla
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain.,Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.,Department of Cell Biology, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Suresh Kumar Kamalakannan
- Public Health Foundation of India (PHFI), South Asia Centre for Disability Inclusive Development and Research (SACDIR), Indian Institute of Public Health - Hyderabad (IIPH-H), Hyderabad, India
| | - Michel D Landry
- School of Medicine, Duke University, Durham, NC, USA.,Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
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Khalil DM, Elmorsy E, Arafa A, Nafady HA, Saleh L. Factors affecting prehospital time delay of the injured patients arriving at the Emergency Department of Beni-Suef University Hospital in Egypt: A cross-sectional study. PLoS One 2021; 16:e0252044. [PMID: 34077438 PMCID: PMC8172024 DOI: 10.1371/journal.pone.0252044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 05/08/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE This study aimed to assess the factors affecting the prehospital time delay of the injured patients arriving at the Emergency Department of Beni-Suef University Hospital in Upper Egypt. MATERIALS AND METHODS In this cross-sectional study, the following data were retrieved from the hospital records of 632 injured patients between 1/1/2018 and 31/3/2018: age, sex, residence, means of transportation to the hospital, prehospital time delay, consciousness level on admission, source of injury, and type of worst injury. RESULTS The prehospital time delay (>one hour) of the injured patients was positively associated with age >60 years and rural residence but inversely associated with consciousness level with odds ratios (95% confidence intervals) of 5.14 (2.26-11.68), 3.49 (2.22-5.48), and 0.56 (0.32-0.96), respectively. CONCLUSION The prehospital time delay of the injured patients arriving at the Emergency Department of Beni-Suef University Hospital in Egypt was associated with old age, rural residence, and consciousness level.
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Affiliation(s)
- Doaa Mahmoud Khalil
- Department of Public Health and Community Medicine, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
- * E-mail:
| | - Elmorsy Elmorsy
- Department of Public Health and Community Medicine, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Ahmed Arafa
- Department of Public Health and Community Medicine, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hesham Ahmed Nafady
- Department of General Surgery, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Lamiaa Saleh
- Department of Public Health and Community Medicine, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
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Cullen P, Möller H, Woodward M, Senserrick T, Boufous S, Rogers K, Brown J, Ivers R. Are there sex differences in crash and crash-related injury between men and women? A 13-year cohort study of young drivers in Australia. SSM Popul Health 2021; 14:100816. [PMID: 34041353 PMCID: PMC8141461 DOI: 10.1016/j.ssmph.2021.100816] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/19/2021] [Accepted: 05/06/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Young men have long been known to be disproportionately impacted by road crash and crash-related injury compared to young women and older drivers. However, there is limited insight into how sex differences in crash and crash-related injury changes over time as men and women get older and gain more driving experience. To explore sex differences in crash and crash-related injury, we undertook a sex disaggregated analysis in a large longitudinal cohort of over 20,000 young drivers in New South Wales, Australia, for up to 13 years after they first attained their independent car driver licence. METHODS DRIVE Study survey data from 2003-04 were linked with police, hospital and deaths data up to 2016. Sex differences were analysed using cumulative incidence curves investigating time to first crash and in negative binominal regression models adjusted for driver demographics and crash risk factors. RESULTS After adjusting for demographics and driving exposure, compared with women, men had 1.25 (95% CI 1.18-1.33), 2.07 (1.75-2.45), 1.28 (95% CI 1.13-1.46), 1.32 (95% CI 1.17-1.50) and 1.59 (95% CI 1.43-1.78) times higher rates of any crash, single vehicle crash, crash on streets with a speed limit of 80 km/h or above, crash in wet conditions and crash in the dark, respectively. By contrast, men were less likely to be involved in crashes that resulted in hospitalisation compared to women 0.73 (95% CI 0.55-0.96). CONCLUSIONS Young men are at increased risk of crash, and this risk persists as they get older and gain more driving experience. Despite lower risk of crash, women are at higher risk of crash related injury requiring hospitalisation. These differences in men's and women's risk of crash and injury signal the need for better understanding of how sex and/or gender may contribute to risk of crash and injury across the life-course.
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Affiliation(s)
- Patricia Cullen
- School of Population Health, UNSW, Sydney, Australia
- The George Institute for Global Health, UNSW, Sydney, Australia
- Ngarruwan Ngadju: First Peoples Health and Wellbeing Research Centre, University of Wollongong, NSW, Australia
| | - Holger Möller
- School of Population Health, UNSW, Sydney, Australia
- The George Institute for Global Health, UNSW, Sydney, Australia
| | - Mark Woodward
- The George Institute for Global Health, Imperial College, London, UK
| | - Teresa Senserrick
- Queensland University of Technology (QUT), Centre for Accident Research and Road Safety – Queensland, Kelvin Grove, QLD, 4059, Australia
| | - Soufiane Boufous
- Transport and Road Safety (TARS) Research, UNSW, Sydney, Australia
| | - Kris Rogers
- The George Institute for Global Health, UNSW, Sydney, Australia
- Graduate School of Health, The University of Technology Sydney, Australia
| | - Julie Brown
- The George Institute for Global Health, UNSW, Sydney, Australia
| | - Rebecca Ivers
- School of Population Health, UNSW, Sydney, Australia
- The George Institute for Global Health, UNSW, Sydney, Australia
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