Road accident rates: strategies and programmes for improving road traffic safety

Introduction

Nowadays, the problem of road accident rates is one of the most important health and social policy issues concerning the countries in all continents. Each year, nearly 1.3 million people worldwide lose their life on roads, and 20–50 million sustain severe injuries, the majority of which require long-term treatment.

Discussion

The objective of the study was to identify the most frequent, constantly occurring causes of road accidents, as well as outline actions constituting a basis for the strategies and programmes aiming at improving traffic safety on local and global levels. Comparative analysis of literature concerning road safety was performed, confirming that although road accidents had a varied and frequently complex background, their causes have changed only to a small degree over the years. The causes include: lack of control and enforcement concerning implementation of traffic regulation (primarily driving at excessive speed, driving under the influence of alcohol, and not respecting the rights of other road users (mainly pedestrians and cyclists), lack of appropriate infrastructure and unroadworthy vehicles.

Conclusions

The number of fatal accidents and severe injuries, resulting from road accidents, may be reduced through applying an integrated approach to safety on roads. The strategies and programmes for improving road traffic should include the following measures: reducing the risk of exposure to an accident, prevention of accidents, reduction in bodily injuries sustained in accidents, and reduction of the effects of injuries by improvement of post-accident medical care.

     

Prevention of bicycle accidents.

OBJECTIVE: To elucidate the way of reducing the number of bicycle accidents. A prospective study of all casualties from bicycle accidents attending an accident unit for a 29-month period was performed (1831 patients). A more detailed questionnaire on the causes of accidents was used for the last 12 months of the study (818 patients). RESULTS: In the 0-7 and 8-12 years age groups, 87.5 per cent and 66.2 per cent, respectively, were due to cyclist error. The 8-12-year-old cyclists were twice as likely to have caused the accident if they had not had formal training (risk ratio = 2.0). Over the age of 18 years, 41.4 per cent were due to another road user. A motor vehicle was involved in 633 of the 1831 accidents. CONCLUSIONS: Children under the age of 8 years should not be allowed on public roads. Older children should only be allowed on the roads after formal training. This should become part of the school curriculum. A campaign to increase the awareness of motorists would be expected to reduce the number of cycle accidents. It would be beneficial to dedicate more roads and tracks to cycle use. Cyclists should be encouraged to wear more protective gear.     

TS01SINGLE VEHICLE ROLL OVER ACCIDENTS: AN UNIQUE PATTERN OF MOTOR VEHICLE ACCIDENTS IN CENTRAL AUSTRALIA

The single vehicle rollover accident is a highly complex crash mode and there is growing concerns about its incidents and consequences in central Australia. The aim of this paper is to assess:

• 1 The incidence and injury patterns of rollover accidents
• 2 Pre rollover characteristics on rollover propensity
• 3 The injury severity and outcome of rollover accidents

The absence of speed limit, unfenced roads, vast distances traveled, unsealed roads and high use of alcohol makes the spectrum of MVA’ s in NT unique. In this two year period of study from Jan 2004 – Dec 2005, there were 470 motor vehicle accidents of which 126 were single vehicle rollover accidents. 132 patients were admitted; 73 NT residents of which 45 were of aboriginal origin and 14 were international tourists. There were 37 deaths in Central Australian roads and 20 were due to single vehicle rollover accidents. None of the deaths occurred at the Alice Springs hospital . Most rollover accidents occur at a speed above 100 km/h. 24 patients had an ISS > 15 and 35% of all injuries were to head, neck and shoulder. Rollovers occurred when the vehicle left the road way and encountered a tripping mechanism such as soft dirt or loose gravel. Those who were belted fared better than those unbelted occupants. Completely ejected occupants were all unbelted. Mean time to hospital from time of accident was 8Hrs. Primary prevention strategies need to involve remote communities, tourists traveling in central Australia and address alcohol and restraint use.     

Epidemiological characteristics of fatal pedestrian accidents in Fars Province of Iran: a community-based survey

Objective: To determine the epidemiological characteristics of fatal pedestrian accidents in Fars Province of Iran.Methods: This cross-sectional study was conducted in Fars Province of Iran during a 29-month period from March 2009 to July 2011.The data were from the Fars Forensic Medicine Registry.In 4 923 recorded road traffic accident fatalities,971 deaths were due to pedestrian accidents.The demographic and accident-related information were analyzed by SPSS version 11.5.P value less than 0.05 was considered significant.Results: The mean age of decedents was (47.2±26.2)years,ranging from 6 months to 103 years old.Males accounted for 69.8％ of all deaths.Fatal accidents were most common in September; 56.1％ of the fatal injuries occurred on intracity roads and 33.1％ on extracity roads.Fatal head injuries were present in 60.54％ of cases.Evaluation of the injury site and the cause of death found that they were significantly associated with age,interval between injury and death.Besides,the type of roads played an important role in mortality.Conclusion: Although the clinical management of trauma patients has been improved in our country in the recent decade,decreasing the burden of injuries needs coordination among trauma system organizations.     

Epidemiology of traffic accidents in France

The prevalence of deaths due to traffic accidents in France is approximately 20/100,000 inhabitants (1988). This places France 9th in Europe. Sixty-five percent of the accident population are between 16 and 65 years old. Sixty-three percent of deaths occur in people who are in passenger cars, while 11% are pedestrians. There were six deaths for every 100 accidents in 1988. The number of corporal accidents and deaths were 22.6% and 37.2%, respectively, on turnpikes, 31.3% and 47.2%, on rural roads, and 46.1% and 15.6% on urban networks. The two most commonly incriminated factors were speeding and drunken driving. Speeding was responsible for one out of six deaths on turnpikes and national roads, one out of two on urban and rural roads. Costs were 53,000,000 FF in 1988, 47,000,000 FF going in work compensations and lost working days. Prevention measures include improvement of supervision of road networks, especially in rural areas, more severe fines with reinforced fool-proof paying conditions, mandatory seat-belts for passengers in the front and back of cars, as well as continuous education for drivers.     

Analysis of risk factors contributing to road traffic accidents in a tertiary care hospital. A hospital based cross-sectional study

Purpose: Road traffic accidents (RTAs) are a public health issue and cost a lot to individuals, families, communities and nations. Trauma care systems in India are at a nascent stage of development. There is gross disparity between trauma services available in various parts of the country. Rural area in India has inefficient services for trauma care, due to the varied topography, financial constraints, and lack of appropriate health infrastructure. The present study is to study the trends of occurrence of RTA cases by month, week and time of accident occurrence as well as to research the types of vehicle involved in accidents and other various risk factors related to them. Methods: During 1st January 2017 to 31st December 2017, a hospital-based and cross-sectional study of RTA victims was conducted. The patients were admitted in emergency department of Uttar Pradesh University of Medical Sciences, Saifai, Etawah, when stabilized, they were shifted to the orthopaedics and surgery ward. Results: In the study, 654 road accident victims were included, of which the majority were males (77.5%) and the most of them belonged to rural (67%). RTA victims according to the month of occurrence majority were found in January (12.5%) and evening was time of a day with maximum accidents (32.1%). Mortality cases of RTA victims based on type of road user and it shows decreasing trend of mortality of motorcyclists (54.2%) followed by pedestrian (25.1%). Conclusion: There should be control over people driving vehicles under the influence of alcohol and drivers over-speeding and rash driving on urban roads as well as rural village roads.     

Foot‐and‐mouth disease outbreaks in captive scimitar‐horned oryx (Oryx dammah)

This paper describes three episodes of foot‐and‐mouth disease (FMD) that were detected during 2013–2015 in scimitar‐horned oryx (Oryx dammah) (SHO), a large Sahelo‐Saharan antelope extinct in the wild housed in a wild ungulate breeding facility located 50 km east of Abu Dhabi, United Arab Emirates. While no mortality attributable to FMD was noted in the population of nearly 4,000 SHO during two of the three outbreaks, the morbidity varied according to the circulating strains and seroconversion reached a plateau of 78.0% within two weeks and remained at this level for at least nine months. Partial or complete sequencing of the VP1 encoding region demonstrated that the three outbreaks were caused by three different FMDV lineages (O/ME‐SA/PanAsia‐2, A/ASIA/Iran‐05 and O/ME‐SA/Ind‐2001), consistent with FMD viruses that are circulating elsewhere in the region. These findings demonstrate that SHO are susceptible to FMD and highlight the risks of virus incursion into zoos and captive facilities in the Arabian Peninsula.     

Road crash in China from 2003 to 2005

Objective： To analyze characteristics and causes of road crash and injuries in China from 2003 to 2005.
Methods： The data of road crash in 2003-2005 were collected to study the characteristics including total vehicle number, occurrence rates of traffic accidents and serious traffic accidents so as to discuss the causes and characteristics of road crash in China.
Results： From 2003 to 2005, the numbers of traffic accidents, injuries and deaths as well as the mortality rates per 100 000 persons and per 10 000 vehicles declined in China. Until 2005, the total number of traffic accidents decreased to 450 000 and deaths to 99 000, with the mortality rate per 10 000 vehicles being 7.6 persons. While the drivers and passengers accounted for 33.2 % and 26.6 % of death casualties respectively in 2005. Most traffic accidents were caused by drivers, especially those with driving experience less than 3 years. Traffic accidents occurred on suburban roads accounted for 60%. The mortality rate of the traffic accidents per 100 km on the first grade road ranked the highest. The mortality rate of the traffic accidents on expressways ranked the highest, with continual increase of death and injury.
Conclusions. At present, the increase trend of traffic accidents and casualties in China has been slowed down to some extent and shows a declining tendency, but the situation is far away from being optimistic. In order to cut down the number of traffic accidents and casualties, we should pay more attention to training and managing drivers with less than three driving years and those driving buses. Strict prevention measures should be laid on traffic accidents on first grade roads, expressways and suburban roads as well as the enhancement on improving first-aid system.     

Screening colonoscopy in the initial workup of bariatric surgery patients: guidelines are needed

Background

Cancer is one of the most common causes of death among morbidly obese individuals. Obese individuals have a well-documented increased risk of colon cancer. No guidelines are available for the workup of bariatric surgery patients in relation to colon cancer.

Methods

The indications for screening colonoscopy at the Bariatric and Metabolic Institute Abu Dhabi (BMI Abu Dhabi) include all patients older than 50 years [40 years if patients are United Arab Emirates (UAE) nationals] with unexplained abdominal symptoms, anemia of unknown cause, or a family or personal history of colonic pathology. This study retrospectively reviewed the charts of all the patients who had colonoscopy during the period January 2009 to January 2013. The patients were divided into two groups: group A [patients with a body mass index (BMI) > 30 kg/m²] and group B (patients with a BMI < 30 kg/m²). The demographics and the prevalence of polyps and cancer in the two groups were compared.

Results

During the study period, 341 colonoscopies were performed: 137 for patients with a BMI higher than 30 kg/m² (mean age, 44 years) and 204 for patients with a BMI lower than 30 kg/m² (mean age, 46 years) (P > 0.05). The overall prevalence of adenomatous polyps was 6.74 % and that of cancer was 1.75 %. Further analysis showed that the prevalences of adenomatous polyps and cancer were respectively 12.4 and 2.1 % for the patients with a BMI higher than 30 kg/m², whereas the prevalences were respectively 2.9 and 0.9 % for the patients with BMI lower than 30 kg/m² (P < 0.001).

Conclusion

The risk for the development of colonic adenomatous polyps and cancer is high among young obese individuals in the Middle East. Guidelines are needed to establish criteria for screening in this group of individuals.     

Road traffic safety: An analysis of the cross-effects of economic, road and population factors

Purpose: Through the study of economic, traffic and population data related to road traffic accidents from 2004 to 2016, this paper analyzed the impact of various factors on road traffic casualties in China, and provided theoretical basis and suggestions for the road traffic safety management in China. Methods: Based on three aspects (economy, road, population) with five factors (gross domestic product (GDP), traffic investment, new vehicle ownership, new road mileage and newly increased population), this paper collected the relevant data of road traffic accidents in 31 provinces and cities in China, from 2004 to 2016. A panel model was established to carry out empirical analysis. Results: All factors have a significant impact on the number of road traffic accident casualties. When other factors remain unchanged, the number of road traffic casualties decreased by an average of 0.19 for every 100 million CNY increased in GDP. For every 100 million CNY increased in traffic investment, the number of road traffic casualties is reduced by an average of 13.93, indicating that economic develop ment can improve road traffic safety to a certain extent. On the contrary, the growth in road mileage, new motor vehicles and population has increased the number of road traffic casualties. For every 10, 000 km of new road mileage, the number of traffic accident casualties has increased by 284.04. For every 10,000 newborns, the number of road traffic casualties increased by 7.33; as the number of new motor vehicles increases by 10,000, the number of road traffic casualties increased by an average of 21.77. Conclusion: The increase of GDP and traffic investment can significantly reduce the number of road traffic casualties in China, which shows that economic development is essential to improve road traffic safety. The numbers of new road mileage, newly increased population and the new motor vehicles are positively correlated with the number of traffic accident casualties in traffic accidents, which reflects the existing problems in road design, distribution of road resources, and traffic management in China. Therefore, it is necessary to improve the economic and road related aspects to improve road traffic safety.     

Biosecurity Measures Applied in the United Arab Emirates – a Comparative Study Between Livestock and Wildlife Sectors

In 2013, the livestock population in the UAE exceeded 4.3 million heads with sheep and goats accounting for 90% of this. The overall number of captive wild ungulates (gazelle types) is difficult to assess as there is no registration system in place or enforced in the UAE with regard to the possession of wildlife. Those animal collections, mainly owned by high‐ranking families, are therefore not registered and kept far from public viewing. Nonetheless, some collections are housing more than 30 000 ungulates in one location. The primary objective of this study was to describe the biosecurity measures currently applied in UAE ungulate facilities for different wildlife and livestock sectors. A secondary objective was to use the output from this biosecurity survey to investigate which sector could be categorized into risk groups for disease introduction and spread. Between October 2014 and May 2015, biosecurity questionnaire data were collected in the Emirates of Abu Dhabi, Dubai, Ras Al Khaimah, Fujeirah, Ajman, Umm al Quwain and Sharjah from 14 wildlife collections, 30 livestock farms and 15 mixed (wildlife and livestock farms). These investigations through questionnaires allowed us to quantify and assess statistically biosecurity practices and levels for both livestock and wildlife sectors. In both sectors, biosecurity measures could be improved and only a few facilities had high biosecurity scores. The group of small unregistered farms (Ezba) represented the highest risk of disease transmission to other animals due to their lack of biosecurity awareness.     

Scutting: a dangerous pastime?

Scutting is a pastime which has taken place in Dublin for many years. To scutt is to gain a ride on the back of a moving vehicle holding onto it by any means possible. Injuries sustained while scutting have never previously been reported.

A total of 38 children presented at the Accident and Emergency Department of The Children's Hospital, Temple Street during the period January 1985 to July 1987 with injuries sustained while scutting. The injuries were analysed with regard to type, pattern, severity and outcome; nine children died from their injuries and 34.2 per cent of the children were admitted to hospital with an average stay of 5 days. All of those admitted alive made a full recovery.

Comparison is made with other more everyday sensible pastimes and with road traffic accidents involving children. Scutting is shown to be the most dangerous pastime and is responsible for more deaths than any other type of road traffic accident involving children. Suggestions are made to stop this pastime taking place.     

Analysis on the accident casualties influenced by several economic factorsbased on the traffic-related data in China from 2004 to 2016

Purpose: By studying the economic data related to road traffic accidents in recent 10 years, this paper explores the impact of various economic factors on the number of casualties in traffic accidents in China, and puts forward related prevention and management measures. Methods: Based on five economic factors including the number of new health institutions, health investment, transportation investment and disposable income per capita, this paper collects the data of traffic accidents in 31 provinces and municipalities of China from 2004 to 2016 and estimates the parameters using fixed effect model. Results: The number of health institutions, health investment, transportation investment and disposable income per capita are negatively correlated with the number of traffic accident casualties; the number of new health institutions is positively correlated with the number of traffic accident casualties; health investment and transportation investment have a great impact on the number of road traffic accident casualties. Conclusion: Economic development has a positive impact on improving traffic conditions, but the increase in the number of new health institutions does not reduce the number of casualties in accidents. The irrational layout of health institutions and imperfect road traffic management mechanism should be taken into account.     

Use of social media while driving from an orthopedic resident's perspective

Purpose: To investigate the orthopedic injuries sustained while driving and using social media on cellular phones from an orthopedic resident''s perspective. Methods: A total of 118 patients who presented with a history of road traffic accident secondary to social media usage and suffered from fractures were included in this cross-sectional study. These patients were reported from October 2018 to April 2019. We collected the data including the type of collision, type of social media usage during driving, location of injury, wearing of safety equipment''s such as helmet and seat belt during driving. Results: The mean age of patients was (34.86 ± 12.73) (range 15-71) years. The common types of accident on the basis of collision of vehicles were: car versus motorbike 45 (38.1%), motorbike versus motorbike 28 (23.7%), and motorbike versus pedestrian 22 (18.6%). Most of the accidents (61, 51.7%) occurred due to mistake of motor-bikers. Out of them, 44 (37.3%) occurred on traffic signals, followed by 29 (24.6%) while driving on main roads. The common timing of accident was normal hours with frequency of 44 (37.3%), followed by 39 (33.1%) at late night. According to fracture type, closed injuries were 98 (83.1%) and open fractures were 20 (16.9%). The most common fracture was clavicular fracture (21,22.5%) followed by soft tissue injury in 19 (16.1%) patients. The most common social media application usage during driving was Facebook 43 (36.4%), followed by Whatsapp 24 (20.3%), Google 19 (16.1%), and Instagram 15 (12.7%). Conclusion: This study provides evidence that social media usage while driving put the drivers and other road users'' lives at high risk. The most common social media addiction while driving is Facebook and Whatsapp. So there is a need to make strict rules and penalties for using cell phone during driving so as to save the lives of drivers and other people using road.     

Applying Haddon Matrix for Evaluation of Road Crash Victims in Delhi,India

Road traffic injuries are placing an increasing and disproportionate global health burden upon developing countries. An understanding of region specific epidemiological risk factors is imperative in order to plan appropriate prevention and control strategies. The objective of the study was to evaluate epidemiological risk factors of road traffic injury victims in Delhi, India with the help of Haddon injury analysis framework. The current study was conducted among crash victims admitted to the government hospital. Data obtained from the hospital, police records and crash victims was triangulated with geospatial analysis. Haddon matrix was utilized to understand the interplay of human, vehicle and environmental factors in pre-crash, crash and post-crash phases of an accident. A total of 544 victims were included as study participants with mean age of 30.8 years for males and 31.81 years for females and were from lower socio-economic groups. Pedestrians (36.2%) and two-wheeler riders, especially those on pillion vehicles (21.5%), were worst affected victims. The crude odds ratio for motorized road users for experiencing a crash was higher on slippery roads [p < 0.05; OR = 0.197 (0.082–0.474)]. Moderate to heavy traffic flow (p = 0.001; OR = 0.469 (0.317–0.696) was found to be a protective factor for accidents. Geospatial analysis revealed clustering of crashes near traffic lights, markets and schools. Integrated approaches addressing engineering, technological and environmental factors along with behavioural modifications is needed to produce definitive changes in road crash trends.     

Single-Stage Operative Management of Laparoscopic Sleeve Gastrectomy Leaks Without Endoscopic Stent Placement

Background

Leaks occur in 1.4–20 % (Bohdjalian et al., Obes. Surg. 20:535–540, 2010; Nocca et al., Obes Surg. 18:560–565, 2008; Stroh et al., 19:632–640, 2009; Aurora et al., Surg. Endosc. 26:1509–1515, 2012) of patients following laparoscopic sleeve gastrectomy (LSG). Leaks may lead to major morbidity and prolonged hospitalization. Endoscopic stent placement is a potential management strategy that needs expertise and also has recognized complications (stent migration, significant dysphagia, and failure) (Rosenthal et al., Surg. Obes Relat. Dis. 8:8–19, 2012). A standard method of managing leaks following LSG has not been established. This study aims to evaluate the outcomes of consecutive patients with leaks following LSG managed at BMI Abu Dhabi Tertiary Multidisciplinary Bariatric Surgery, Abu Dhabi, UAE.

Methods

We examined all patients presenting to BMI Abu Dhabi between February 2010 and May 2012 with leaks following LSG. Data were obtained from the hospital medical record, and IRB approval was obtained. All patients were managed by utilizing a standardized operative management strategy without the use of endoscopic stenting.

Results

A total of five patients were referred to us for higher level of care; during the same time period, we performed 71 LSGs without a leak. Patients were optimized and resuscitated adequately before surgery. Intraoperatively, all patients had endoscopy, and a T tube was placed inside the leak if clearly identifiable. Otherwise, the leak site was drained adequately without attempting to place sutures, and a jejunostomy tube was inserted. All leaks healed following an initial period of hospital stay, followed by an outpatient period on jejunostomy tube feeding and nil per os.

Conclusion

Single-stage operative management of leaks after LSG utilizing a standardized operative strategy without the use of endoscopic stenting is both safe and effective.     

The burden of post-traumatic amputations in a developing country – An epidemiological study from a level I trauma centre

BackgroundWith the rapidly growing population and expanding vehicle density on the roads, there has been an upsurge in road accidents in developing countries. Knowledge about the causes and patterns of trauma-related amputations helps in the formulation of strategies for limb savage, timely management, and effective rehabilitation.ObjectiveTo study the epidemiology, demographic profile, and outcomes of post-trauma amputations at a level I tertiary care centre in North India.MethodsRetrospective evaluation of the amputee data from 1st January 2018 to 31st December 2019, focusing on demographic details, injury mechanisms, surgical delays, hospital stay, and complications.ResultsA total of 17,445 trauma cases were seen in our trauma centre during the study period. Of these, 442 patients (2.5%) underwent major limb amputation. The hospital-based prevalence of traumatic limb amputation was 2.5%. The mean age of the amputees was 35.6years (range 1–75), and the majority were males (n = 369, 83.5%). The lower to upper limb involvement ratio was 3:1 (n = 338:105). A road traffic accident was the most common mode of injury (77.4%), followed by machine-cut injuries (16.1%). On-site traumatic amputation was seen in 23.1% (n = 102), while 43.5% had a mangled limb amputated in the hospital (mean MESS score 9.53). Overall, 27% of cases had a vascular injury after trauma, ultimately ending in limb amputation. The in-hospital mortality was 2% (n = 9/442). 43.7% of patients with a single limb amputation were discharged within 48 h. Extended hospital stay was noted in cases with associated fractures in the other limbs (28.5%), head or facial injury (9.9%), and with or without a combination of chest, abdomen, pelvic, or spine injury (7.2%).ConclusionA 2.5% incidence of post-trauma amputation reflects on the severity of injury related to road and industrial accidents which predominantly affect the lower limbs at the peak of productive work life. In the absence of national amputation registries, the results underscore the need to focus on road safety protocols, patient transfer methods, and the up-gradation of local hospitals.     

Prevalence of seat belt and mobile phone use and road accident injuries amongst college students in Kerman,Iran

Objective: To investigate the prevalence of mobile phone and seat belt use in driving in college students aged 18-24 years.Methods: The study consisted of two phases. In the first phase, a questionnaire was given to 265 college students. The sample contained 188 males and 77 females.In the second phase, the data pertaining to road accident injuries from March 20, 2007 to March 20, 2008 were collected from Bahonar Central Hospital in Kerman, Iran, and analyzed.Results: There were 14.0% of male and 19.0% of female participants traveled belted while driving on urban roads. It indicated that the participants unbelted or using mobile phone were more involved in accidents in last three years. This study also revealed that 19.0% of male and 4.2%of female drivers considered using mobile phone in driving not hazardous. The highest injury and property damage crash rates were 87 and 137 per 100 000 inhabitants, which occured in male group aged 18-24 years. And 30% of all fatalities were 19-24 years old.Conclusions: More than 50% of college students traveled unbelted. The females were less involved in road accident injuries. The college students aged 18-24 years had the highest percentages of trauma and head injury.