行人分心流行特征与干预研究进展

行人分心是交通伤害的重要危险因素之一。本文就国内外行人分心流行特征、影响因素、安全影响,以及现有干预措施进行综述。结果显示:①行人分心发生率高,严重威胁行人安全,但当前大多数行人分心流行特征研究集中于手机使用,采用不同研究方法、来自不同国家的行人分心发生率存在较大差异;②人口学特征、社会心理和环境是行人分心发生的主要影响因素;③行人分心通过对生理认知、运动控制、过街效率和过街行为造成不同程度的影响,威胁行人安全;④工程干预和教育是最常见的行人分心干预措施,但大多数措施的效果未被严格评估。建议未来从多学科角度开展深入的流行病学研究,精准设计干预措施,严格评估干预措施的效果,为减少行人分心、提高行人交通安全提供科学依据。     

基于视频拍摄的长沙市十字交叉路口行人过街分心的流行特征分析

  目的  分析长沙市过街行人常见分心类型的流行特征。  方法  采用多阶段随机抽样获取研究对象，通过视频拍摄和人工转录获得长沙市20个十字交叉路口过街行人的常见分心发生率及其特征(包括:发生频次、分心时长)。采用χ2检验、Cochran-Armitage趋势检验、Kruskal-Wallis H检验进行统计分析。  结果  共观察到25 436名20岁及以上过街行人，分心发生率为34.32%(95% CI: 33.73%~34.90%)，女性、20~＜40岁、下午和周末出行行人的分心发生率分别高于男性、其他年龄组、上午和工作日出行者(均有P < 0.05)。手机使用、与其他行人交谈、吃喝东西/吸烟的发生率分别为11.06%、19.62%和2.13%。三类分心的发生频次均以1~2次为主，与其他行人交谈(10.0 s)的中位分心时长高于手机使用(9.0 s)和吃喝东西/吸烟(8.0 s)。  结论  长沙市十字交叉路口过街行人分心发生率高，与其他行人交谈和手机使用是最常见的分心类型。不同分心类型的发生频次和分心时长存在差异。     

社会心理因素与交通环境对行人分心的联合影响

  目的  基于联合行为模型检验社会心理因素和交通环境对使用手机、与同行人员交谈、吃喝东西/吸烟3类行人分心的联合影响。  方法  采用多阶段随机抽样法抽取长沙市20个十字交叉路口作为研究现场,综合使用视频拍摄和现场问卷调查收集行人分心、社会心理因素和交通环境等数据。参照联合行为模型,从行人对不同分心的态度、主观规范、个人能动性和分心习惯等社会心理因素角度设计调查问卷。采用结构方程模型检验社会心理因素和交通环境对行人分心的联合影响。  结果  研究者共邀请到1 974名行人参与问卷调查,其中有效问卷1 741份(手机使用问卷600份、与同行人员交谈问卷660份、吃喝东西/吸烟问卷481份)。个人态度、主观规范、个人能动性、意图、分心习惯和交通环境因素共同解释行人手机使用、与同行人员交谈和吃喝/吸烟分心变异的22%、18%和23%。个人能动性、主观规范、个人态度是手机使用分心的主要解释因子,其间接效应分别为0.126、0.110和0.102(均有P＜0.05);分心习惯是与同行人员交谈、吃喝东西/吸烟分心的主要解释因子,其总效应分别为0.158和0.250(均有P＜0.05)。交通环境对3类行人分心的影响均无统计学意义。  结论  社会心理因素和交通环境共同影响手机使用、与同行人员交谈和吃喝东西/吸烟3类行人分心的发生,不同分心的主要解释因子存在差异。未来应针对不同行人分心的主要解释因子,综合采用教育、立法和工程干预以减少行人分心。     

竹山县艾滋病流行病学调查及高危行为干预效果

目的 掌握艾滋病的流行特征、研究其流行因素,探索预防艾滋病的干预方法和措施. 方法 对现有相关资料进行统计,用描述流行病学方法对艾滋病流行特征、流行因素进行分析;采用心理干预和行为干预两种方法并行,对娱乐场所女性性服务人员实施干预,并对干预前后效果进行比较. 结果竹山县2002年6月-2008年底累计发现艾滋病病毒感染者和病人66例,疫情分布具有明显的地域聚集性,年龄主要是25～50岁的青壮年,均为农民,经血液途径传播者占63.64%,性途径传播者占30.30%.经济贫困、人口流动,农村卫生条件差、妇女生殖道感染率高(48.71%),群众防治知识缺乏是本地区艾滋病流行的主要因素.干预后艾滋病知识知晓率、安全套使用率均明显提高,性病感染率下降61.51%. 结论基本摸清本地区艾滋病的流行特征和流行因素,对高危人群采取的两种干预方法并行切实有效.解决农民工夫妻分居或就地有序安排就业,是预防和控制艾滋病、性病的重要措施,也是各级政府急需研究解决的系统工程和重要课题.     

芜湖市高校大学生伤害的流行病学特征分析

目的探讨大学生伤害的流行病学特征及影响因素,为建立有效的干预措施提供依据。方法采用整群抽样方法抽取某高校二年级大学生1925名进行伤害的流行病学调查分析。结果大学生伤害的年发生率为64.9%;前5位伤害依次为：跌落伤（45.7%）、刀割伤（19.5%）、烧烫伤（10.6%）、咬伤（7.7%）、交通事故（3.7%）;男生的伤害发生率高于女生（P〈0.05）;不同年龄大学生的伤害发生率差异无统计学意义（P〉0.05）;多次伤害发生率较高（50.1%）。结论预防大学生伤害的关键在于加强安全教育,提高大学生自我防范和自我保护意识,减少大学生伤害的发生。     

山东省某高校大学生伤害现状与微信干预效果研究

目的探讨大学生伤害的特征及影响因素,提出干预措施并评价干预效果,为控制伤害的发生提供科学依据。方法采用分层整群随机抽样的方法,抽取山东省某综合性高校大学生共2 068人,进行伤害情况的基线调查并应用微信平台进行干预研究。结果大学生的伤害发生率为14.02%,男生伤害发生率(17.86%)高于女生(10.38%),离异家庭伤害发生率(21.79%)高于非离异家庭(13.39%),有多发性既往伤害史的大学生伤害发生率(19.93%)高于没有的大学生(12.32%),差异有统计学意义(P0.05);男生前3位的受伤类型是碰撞伤、跌落伤和交通事故伤,女生则是碰撞伤、交通事故伤和跌落伤;月生活费、心理问题、睡眠不足、伤害既往史和同学关系是伤害的影响因素;微信干预后大学生3次及以上的伤害发生率和发生次数下降。结论应根据大学生伤害发生的流行病学特点,采用合理的方式有效降低伤害的发生率,加强安全宣传教育,提高自我保护意识。     

职业病防护干预措施的调查及效果分析

目的对职业病防护干预措施进行调查及对干预效果进行分析。方法对两家(A企业、B企业)主要的焦化企业进行职业卫生现场的调查,分析并评估企业内存在的职业病相关危害因素,并对企业施行的生产流程、防护职业病的相关安全措施、职业卫生的管理手段进行分析,同时分析B企业施行相关安全防护措施前后的体检结果差异。结果采取较完善职业防护措施的B企业,职业病危害因素合格率较高;针对B企业在控制效果评价时存在的问题,提出职业病防护干预措施后职业病危害因素的浓度和强度合格率较整改前明显提高。干预前粉尘、焦炉扩散物、噪声控制合格率分别为89.6%、2 6.0%、60.0%,干预后分别为96.8%、91.6%、70.0%。结论在焦化类别企业中实施规范性的安全防护,可明显降低职业病的发生率。     

闽南地区疟疾流行特征研究与防治效果评价

[目的]探索闽南地区疟疾流行特征和规律,总结干预措施控制疟疾流行的效果及经验。[方法]调查影响疟疾流行的人群及地理分布特征,暴发点分布、流行程度等社会、经济和自然因素,以及媒介按蚊的种群和密度。对有微小按蚊存在的流动人群聚居地、建设工地及丘陵山地村庄等重点防治对象实施综合性干预措施。[结果]疟疾发病数从1994年的1 156例,下降至2004年的11例,37个暴发点全部得到有效控制,无本地传播病例发生,未查到微小按蚊;建立健全了当地疟疾监测和管理系统。[结论]闽南地区采取的抗疟措施得当,疟疾流行已有效控制。     

儿科医护人员职业倦怠现状及其影响因素分析

目的了解并掌握儿科医护人员职业倦怠的现状及相关影响因素,以期为医院制定相应干预措施提供依据。方法于2020年3—5月通过基本信息问卷、职业倦怠量表对我院4个院区的儿科192名医护人员开展调查,基于结果评估儿科医护人员的职业倦怠情况,分析职业倦怠有关影响因素。结果通过调查,192名医护人员中83名存在不同程度职业倦怠,发生率为43.23%,以轻度为主;单因素及多因素logistic回归分析表明,值夜班、用工性质及工作年限是儿科医护人员职业倦怠独立影响因素(P<0.05)。结论儿科医护人员职业倦怠发生率较高,医院管理者应掌握相关因素,制定针对性干预措施,以减小儿科医护人员的职业倦怠感,稳定医护队伍。     

老年人跌倒社区综合干预效果的研究

目的评价社区老年跌倒综合干预措施的效果。方法抽取4个居委会60岁以上老年人,随机分成干预组和对照组,对干预组采取综合干预措施,对照组不采取措施。18个月后,进行干预效果评估。结果干预后干预组跌倒发生率为7.19%,显著低于对照组(17.86%),P0.000。与干预前相比,干预组跌倒发生率降低了10.52%。结论多因素社区综合干预措施能有效减少社区老年人的跌倒发生。     

Use of Google Street View to Assess Environmental Contributions to Pedestrian Injury

Objectives. To demonstrate an information technology–based approach to assess characteristics of streets and intersections associated with injuries that is less costly and time-consuming than location-based studies of pedestrian injury.Methods. We used imagery captured by Google Street View from 2007 to 2011 to assess 9 characteristics of 532 intersections within New York City. We controlled for estimated pedestrian count and estimated the relation between intersections’ characteristics and frequency of injurious collisions.Results. The count of pedestrian injuries at intersections was associated with the presence of marked crosswalks (80% increase; 95% confidence interval [CI] = 2%, 218%), pedestrian signals (156% increase; 95% CI = 69%, 259%), nearby billboards (42% increase; 95% CI = 7%, 90%), and bus stops (120% increase; 95% CI = 51%, 220%). Injury incidence per pedestrian was lower at intersections with higher estimated pedestrian volumes.Conclusions. Consistent with in-person study observations, the information-technology approach found traffic islands, visual advertising, bus stops, and crosswalk infrastructures to be associated with elevated counts of pedestrian injury in New York City. Virtual site visits for pedestrian injury control studies are a viable and informative methodology.In 2013, an estimated 70 000 pedestrians were injured or killed by motor vehicles in the United States.1 Pedestrian deaths as a proportion of overall traffic fatalities have grown from 11% to 14% in the past decade nationally,2 and in New York City more pedestrians than vehicle occupants have been killed by motor vehicles each year since at least 1910.3 On a trip-by-trip basis, a pedestrian is 50% more likely to be killed than a motor vehicle occupant.4 Pedestrian safety is not only vital for public health directly through reduced traffic-related morbidity and mortality, but also indirectly as the perception of increased safety from traffic encourages outdoor physical activity, with consequent mental and physical health benefits.5,6 Investments in pedestrian safety infrastructure may be a particularly cost-effective way to improve population health.7 Recently, several major cities, including New York City, have developed high-profile plans to improve pedestrian safety citywide.8 New York City alone has installed 1500 pedestrian signals and reengineered dozens of roads and intersections.9Although recent studies have suggested that road and pedestrian environment modifications such as improving lighting, adding speed bumps, or maintaining pavement markings can substantially improve pedestrian safety,10–13 such studies have not been as widely replicated, in part because of methodological and logistical challenges of conducting pedestrian environment studies. One 2003 systematic review of literature regarding engineering measures designed to reduce pedestrian–motor vehicle crashes that considered both before and after interventions and location-based case–control designs found at most 3 studies per intervention type and only 1 study for most intervention types.11 The ability to replicate findings is essential to the scientific method and the lack of replication studies undermines weight of evidence and meta-analytical approaches to determining evidence-based best practices.The large burden of injury coupled with the sparse empirical literature justifies more research into risk factors for pedestrian injury and into the effectiveness of interventions. Such studies have, however, typically entailed costly data-collection procedures that require researchers to visit and code every intersection included in the study. Recently, several research teams have validated the use of Google Street View to conduct “virtual” neighborhood audits that obviate the need for field teams to conduct in-person audits.14–18 However, to the best of our knowledge, such approaches have not been used to assess risk factors for pedestrian injury. In this article, we demonstrate an investigation of environmental contribution to injuries by using information technology rather than site visits.     

Pattern of Pedestrian Injuries in the City of Nairobi: Implications for Urban Safety Planning

Pedestrians are overrepresented in road traffic injuries and deaths in Nairobi, the capital city of Kenya, yet little research has been done to provide better understanding of the characteristics of pedestrian injuries. This paper presents the data obtained from road traffic injury admissions to Kenyatta National Hospital (KNH) over a 3-month period starting from 1 June to 31 August 2011. A total of 176 persons involved road traffic injuries in Nairobi were admitted to KNH during this period. Pedestrians comprised the highest (59.1 %) proportion of road traffic injury admissions, followed by motor vehicle passengers (24.4 %) and motor cyclists (9.7 %). Bicyclists and drivers accounted for 5.1 and 1.7 %, respectively. Cars (39.4 %) were the leading category of motorized four-wheeler vehicles that were involved in collisions with pedestrians, followed by matatus (35.5 %). Seventy percent of pedestrians were hit while crossing the road, 10.8 % while standing by the road, and 8.1 % while walking along the road. The highest proportion of pedestrian crashes occurred on Saturdays (25.5 %) and Sundays (16.7 %). Most of the pedestrian injuries (67.7 %) affected the limbs. The paper argues that safety of pedestrians should be a priority in road safety efforts in the city of Nairobi. Urban road safety planners should adopt existing cost-effective interventions to improve the safety of pedestrians such as area-wide traffic calming to limit the speeds of motor vehicles to 30 km/h, providing sidewalks for pedestrians, traffic calming in residential neighborhoods, people-and-not-car-oriented urban road designs, traffic education, and enforcement of traffic regulations.     

Healthy urban environments for children and young people: A systematic review of intervention studies

This systematic review collates, and presents as a narrative synthesis, evidence from interventions which included changes to the urban environment and reported at least one health behaviour or outcome for children and young people. Following a comprehensive search of six databases, 33 primary studies relating to 27 urban environment interventions were included. The majority of interventions related to active travel. Others included park and playground renovations, road traffic safety, and multi-component community-based initiatives. Public health evidence for effectiveness of such interventions is often weak because study designs tend to be opportunistic, non-randomised, use subjective outcome measures, and do not incorporate follow-up of study participants. However, there is some evidence of potential health benefits to children and young people from urban environment interventions relating to road safety and active travel, with evidence of promise for a multi-component obesity prevention initiative. Future research requires more robust study designs incorporating objective outcome measures.     

Child pedestrian injury prevention project: student results

BACKGROUND: Few comprehensive pedestrian safety interventions for primary-school-age children have been developed and evaluated. This paper reports the impact of the 3-year (1995-1997) Child Pedestrian In jury Prevention Project (CPIPP) on a cohort of 1603 children followed from age 6 to 9 years. This multicomponent project comprised an educational intervention for students, their parents and teachers, and the local community, as well as several environmental interventions. The primary aim of CPIPP was to improve children's road-related behavior and to enhance the safety of their road environment. METHODS: Three communities were assigned to the treatment conditions: (1) high-education, community, and environmental interventions; (2) moderate-education intervention only; and (3) comparison (usual road safety education). Children's pedestrian knowledge and road crossing and playing behaviors were assessed using a pre- and posttest self-report questionnaire. Their self-reported road crossing behaviors were validated using an observational schedule and brief interview. RESULTS: Children in the high and moderate intervention groups were significantly more likely to cross the road with adult supervision (P = 0.013) and play away from the road (P = 0.000) than the comparison group. No differences were detected in children's pedestrian safety knowledge between the intervention and comparison groups. CONCLUSIONS: While several methodological limitations may have influenced the study outcomes, these data nonetheless indicate that in the study sample the CPIPP educational intervention deaccelerated the natural increase in children's pedestrian-related risk behavior.     

Distracted Pedestrian Behavior on two Urban College Campuses

Pedestrian injuries injure about 180,000 individuals and kill 6000 each year in the United States, and pedestrian injury rates have increased each of the last several years. Distracted pedestrian behavior may play a role in the trend of increasing risk for pedestrian injury. Using in vivo behavioral coding over the course of  two weeks on two urban college campuses, this study aimed to (1) understand the type and rate of distractions engaged in by pedestrians on urban college campuses, and (2) investigate the impact of distraction on street-crossing safety and behavior. A total of 10,543 pedestrians were observed, 90% of them young adults. Over one-third of those pedestrians were distracted while actively crossing roadways. Headphones were the most common distraction (19% of all pedestrians), followed by text-messaging (8%) and talking on the phone (5%). Women were more likely to text and talk on the phone than men, and men were more likely to be wearing headphones. Distracted pedestrians were somewhat less likely to look for traffic when they entered roadways. As handheld device usage continues to increase, behavioral interventions should be developed and implemented. Changes to policy concerning distracted pedestrian behavior, including improvement of the built environment to reduce pedestrian risk, should be considered in busy pedestrian areas like urban college campuses.     

Deprived children or deprived neighbourhoods? A public health approach to the investigation of links between deprivation and injury risk with specific reference to child road safety in Devon County,UK

Background

Worldwide, injuries from road traffic collisions are a rapidly growing problem in terms of morbidity and mortality. The UK has amongst the worst records in Europe with regard to child pedestrian safety. A traditional view holds that resources should be directed towards training child pedestrians. In order to reduce socio-economic differentials in child pedestrian casualty rates it is suggested that these should be directed at deprived children. This paper seeks to question whether analysis of extant routinely collected data supports this view.

Methods

Routine administrative data on road collisions has been used. A deprivation measure has been assigned to the location where a collision was reported, and the home postcode of the casualty. Aggregate data was analysed using a number of epidemiological models, concentrating on the Generalised Linear Mixed Model.

Results

This study confirms evidence suggesting a link between increasing deprivation and increasing casualty involvement of child pedestrians. However, suggestions are made that it may be necessary to control for the urban nature of an area where collisions occur. More importantly, the question is raised as to whether the casualty rate is more closely associated with deprivation measures of the ward in which the collision occurred than with the deprivation measures of the home address of the child.

Conclusion

Conclusions have to be drawn with great caution. Limitations in the utility of the officially collected data are apparent, but the implication is that the deprivation measures of the area around the collision is a more important determinant of socio-economic differentials in casualty rates than the deprivation measures of the casualties' home location. Whilst this result must be treated with caution, if confirmed by individual level case-controlled studies this would have a strong implication for the most appropriate interventions.

     

Identifying facilitators and barriers for home injury prevention interventions for pre-school children: a systematic review of the quantitative literature

Injuries are the leading cause of childhood death internationally; steep social gradients exist in mortality and morbidity. The majority of pre-school injuries occur in the home, but implementing research into practice for injury prevention has received little attention. This systematic review describes key facilitators and barriers when implementing injury prevention interventions. The review used articles included in a Cochrane systematic review of the effectiveness of home safety education, with or without the provision of safety equipment. Each paper was screened to ensure that children under 5 years, intervention details and process measures and/or barriers and facilitators were included. Two authors independently reviewed each paper and extracted data. Themes were identified and framework analysis used in an iterative process. Ninety-nine papers were identified, 42 excluded and 57 included in the analysis. Seven facilitators and six barriers were identified. Facilitators related to the approach used, focused messages, minimal changes, deliverer characteristics, equipment accessibility, behaviour change and including incentives. The barriers included complex interventions, cultural, socio-economic, physical and behavioural barriers and deliverer constraints. Barriers and facilitators should be addressed when implementing injury prevention interventions and studies should explicitly explore factors that help or hinder the process.     

Epidemiology of work related neck and upper limb problems: Psychosocial and personal risk factors (Part I) and effective interventions from a bio behavioural perspective (Part II)

Work related neck and upper limb symptoms have a multi-factorial origin. Possible risk factors are of a physical, psychosocial or personal origin. These factors can reinforce each other and their influence can also be mediated by cultural or societal factors. Initially, most research on neck and upper limb symptoms focused on work-related physical exposure. Nowadays, psychosocial work characteristics are recognized as important risk factors. Various models have been developed to offer frameworks for possible pathways, but their empirical support is still not conclusive.In part I of this paper an overview is presented of the results of recent epidemiological studies on work related psychosocial and personal risk factors for neck and upper limb symptoms. In addition, the interplay between these factors and the possible intermediate role of an individuals work style in this process is explored. In contrast to previous reviews, it is now possible to base the conclusions on the effect of work related psychosocial factors on neck and upper limb symptoms on quite a few longitudinal studies. These studies show that high work demands or little control at work are often related to these symptoms. However, this relationship is neither very strong nor very specific. Perceived stress is studied in not as many studies but more consistently related to neck and upper limb symptoms. This also applies to general distress or other pain (co-morbidity). Job dissatisfaction does not contribute to neck and upper limb symptoms. Too little research on personal characteristics is available to draw any conclusions. It is plausible that behavioural aspects, such as work style, are of importance in the etiology of work related upper limb symptoms. However, studies concerning these factors are promising but too scarce to draw conclusions. Future studies should address these behavioural aspects.In part II, the recent studies on the effectiveness of preventive measures for work related neck and upper limb problems are discussed. Few randomised or non randomised controlled trials have been carried out to evaluate the effectiveness of individual or organisational interventions to improve work related psychosocial factors. Very few have reported on the preventive effect for work related neck and upper limb symptoms. Therefore, there is a great need for additional high quality trials before any conclusions on effectiveness of bio-behavioural interventions for reduction of neck and upper limb problems and return to work after these symptoms can be made. From the low back pain intervention research can be learned that interventions should best be targeted to both the worker and the organisation and that interventions will only be successful when all stakeholders are involved.