Ari Katila

NOVICE DRIVERS' ACCIDENTS AND VIOLATIONS - A FAILURE ON HIGHER OR LOWER HIERARCHICAL LEVELS OF DRIVING BEHAVIOUR

The study compared accident and offence rates of 28 500 novice drivers in Finland. The purpose was to study differences in accident and offence rates between male and female novice drivers of different age. The drivers reported in a mailed questionnaire, how many accidents they had been involved in and how much they had driven during their whole driving career. All the drivers had a driving experience of 6-18 months. Information about offences for a 2-year period was obtained from an official register of drivers licences. The drivers were classified into three age brackets: 18-20, 21-30 and 31-50 years. The effect of driving experience was controlled by dividing the drivers into different mileage brackets. The data was analysed and the results were discussed in the framework of the hierarchical model of driving behaviour. Young novice drivers and especially young male drivers showed more problems connected to the higher hierarchical levels of driving behaviour than middle-aged novice drivers. The number of accidents and offences was highest among the young males and their accidents took place more often at night than female or older drivers accidents. Female drivers showed more problems connected to the lower hierarchical levels of driving behaviour, e.g. problems in vehicle handling skills. Ways of measuring accident risk of different driver groups were also discussed, as well as the usefulness and reliability of self-reports in accident studies.

Older drivers fail in intersections: speed discrepancies between older and younger male drivers.

A high percentage of older drivers accidents occur in intersections when entering the traffic or crossing a main road. The problems may be in perception or attention, motor performance or inadequate interaction with other road users. Attempts to explain older drivers problems have mostly focused on the properties and behaviour of the older drivers only, without considering the interaction between older and younger road users. The descriptions of older drivers problems in intersections are usually based on accident data. This study aimed to describe the normal behaviour of older drivers, including driving habits, attention patterns and interaction with younger drivers. The driving behaviour of young, old and middle-aged male drivers was studied using video cameras and observers in three T-shaped intersections in Sendai, Japan. The results showed no differences in attention behaviour between the age groups as measured with head movements. The age groups had different acceleration habits and thus different turning time, which also varied depending on whether the vehicle on the main road came from the left or the right. Also the outcome of the turning manoeuvre was dependent on age. The time margins to the vehicles on the main road were shortest when an old driver was turning and a young driver approached on the main road. The time margin between the turning driver and the vehicle approaching on the main road was clearly shorter when the latter vehicle was a motorcycle than if it was a car. The results are discussed in relation to the literature on the risk behaviour of old drivers.

Does increased confidence among novice drivers imply a decrease in safety? The effects of skid training on slippery road accidents

Finnish driver training was renewed in 1990 with the inclusion of a compulsory skid training course in the curriculum. The study evaluated the renewals effect on accidents in slippery road conditions. A questionnaire was sent by mail to 41000 novice drivers who were randomly selected from the official register of driving licences. It included questions on driving exposure and the accidents the drivers had been involved in during 6-18 months following licensing. The rate of return was 74.7%. Half of the drivers had received their licence in 1989 and had, therefore, not received any skid training. The other half had received their licence in 1990 after the introduction of the skid training course. The results showed no effects of the renewal on slippery road accidents for either male or female drivers. Another questionnaire was sent to 1300 old and new curriculum drivers immediately after licensing and a second time 1/2-1 year later, both with questions about skills, worries and perceived risks regarding driving in slippery conditions. The new curriculum drivers showed higher confidence in their skills and they were less afraid to drive in slippery conditions than the old curriculum drivers. This increase in confidence as a result of skid training is discussed. It is argued that high confidence in ones personal skills does not necessarily imply negative safety. The crucial factor is how these skills are used, and for what purpose.

CONFLICTING GOALS OF SKID TRAINING

Efforts to make novice drivers drive more safely on slippery roads by means of special courses have mainly failed. In order to understand why the courses have failed, the views of instructors and students on the goals of skid training courses were compared. The importance given to anticipating vs manoeuvring skills was analysed. After completing a skid training course, students in four Nordic countries (Denmark, Finland, Norway and Sweden) assessed manoeuvring skills to be equally important to anticipating skills in the courses. However, instructors assessed anticipating skills to be more important than manoeuvring skills. The differences between the assessments of instructors and students were the same in all four countries. Manoeuvring exercises are widely used in the courses although the main purpose of these courses is to develop anticipating skills. The exercises may give students the impression that manoeuvring skills are more important than anticipating skills. Manoeuvring exercises also increase their self-confidence and may lead to underestimation of the risks involved, resulting in e.g. driving at higher speed.

Immune response after laparoscopic and conventional Nissen fundoplication.

OBJECTIVEnTo compare the changes in the immune responses of patients undergoing laparoscopic or conventional Nissen fundoplication.nnnDESIGNnProspective randomised clinical study.nnnSETTINGnUniversity hospital, Finland.nnnSUBJECTSn20 patients undergoing Nissen fundoplication for symptomatic erosive oesophagitis.nnnINTERVENTIONnLaparoscopic Nissen fundoplication (n = 10) or conventional open Nissen fundoplication (n = 10).nnnMAIN OUTCOME MEASURESnLeucocyte and differential counts; percentages of lymphocyte subpopulations (CD3, CD4, CD8, CD16 and CD20 positive lymphocytes); and monocytes (CD 14); phytohemagglutinin, concanavalin A and pokeweed mitogen-induced and unstimulated proliferation of separated lymphocytes; plasma interleukin-6 (IL-6), serum C-reactive protein (CRP), albumin, and cortisol concentrations; and group II phospholipase A2 (PLA2) activity.nnnRESULTSnLaparoscopic fundoplication was associated with less tissue damage (IL-6, and CRP concentrations) than the conventional open operation. However, although there were pronounced changes in immune responses over time, there were no differences between the groups.nnnCONCLUSIONnLaparoscopic fundoplication seemed to cause less tissue damage than the conventional open operation, but this difference was not reflected in patients immune responses.

Adenosine-induced cardiac arrest during intraoperative cerebral aneurysm rupture

BACKGROUNDnRupture of an intracranial aneurysm during surgical clipping may have devastating consequences. Should this happen all methods ought to be considered to stop the bleeding. A short-term cardiac arrest induced by adenosine could be a feasible method to help the surgeon. We present our experiences in the administration of adenosine during an intraoperative aneurysm rupture.nnnMETHODSnMedical records of patients who underwent surgical clipping of a cerebral arterial aneurysm were reviewed from 2 university hospitals operative database in the years 2003 to 2008. Patients were included in this study if adenosine had been administered during intraoperative rupture of an aneurysm.nnnRESULTSnAltogether, 16 of 1014 patients were identified with the use of adenosine during an intraoperative rupture of an aneurysm. All of the patients had sinus rhythm and normotension before the rupture of the aneurysm. Twelve patients were administered a single dose of adenosine and 4 multiple boluses for induction of cardiac arrest; the median (range) total dose was 12 (6-18) mg and 27 (18-87) mg, respectively. The clipping of the aneurysm and the recovery of circulation were uneventful in all cases. In a subgroup analysis according to patient outcome as alive/dead, the pre- and postoperative neurologic condition correlated with the outcome, whereas adenosine did not have any effect on the patient outcome.nnnCONCLUSIONnIn a case of a sudden aneurysm rupture, adenosine-induced circulatory arrest could be a safe option to facilitate clipping of an aneurysm. However, if adenosine is used, a very close collaboration between the surgeon and the anesthesiologist is required.

Driving Circumstances and Accidents Among Novice Drivers

Objective. The study evaluated the accident risk of certain driving circumstances and driving motives among novice drivers. Methods. Self-reported exposure and accidents according to driving circumstances and driving motives were compared between young (n = 6,847) and middle-aged (n = 942) male and female novice drivers. For young drivers, self-reported accidents were further compared to fatal accidents (n = 645) in terms of the driving conditions in which they occurred. The survey was conducted in 2002 and the questions regarding the quantity and quality of driving exposure and accidents covered the first four years of the novice drivers driving career after licensing. Data on fatal accidents related to the period of 1990 to 2000. Results. Leisure-time driving, driving just for fun, and driving with passengers and during evenings and at night was more typical for young drivers than for middle-aged drivers. For middle-aged drivers, the most typical driving was driving to or from work. Driving on errands was more typical for females than males. Nighttime driving was overrepresented in young drivers self-reported and fatal accidents, compared to the share of young drivers driving at night. Slippery road conditions were over-represented in young male drivers self-reported accidents, but not in their fatal accidents, whereas for young females slippery road conditions seemed to increase the propensity of fatal accidents. Conclusions. The study concluded that some driving conditions increase the risk of certain types of accidents among certain driver groups, but not among all drivers. For example, slippery road conditions were overrepresented in young male drivers minor (self-reported) accidents, but not in their fatal accidents. For young female drivers slippery road conditions seem to increase the propensity of fatal accidents. Driving circumstances are different in minor (self-reported) and fatal accidents. When drawing conclusions regarding accident risk, it is important to determine the seriousness of the accidents which take place.

Glial Fibrillary Acidic Protein and Ubiquitin C-Terminal Hydrolase-L1 as Outcome Predictors in Traumatic Brain Injury

OBJECTIVEnBiomarkers ubiquitin C-terminal hydrolase-L1 (UCH-L1) and glial fibrillary acidic protein (GFAP) may help detect brain injury, assess its severity, and improve outcome prediction. This study aimed to evaluate the prognostic value of these biomarkers during the first days after brain injury.nnnMETHODSnSerum UCH-L1 and GFAP were measured in 324 patients with traumatic brain injury (TBI) enrolled in a prospective study. The outcome was assessed using the Glasgow Outcome Scale (GOS) or the extended version, Glasgow Outcome Scale-Extended (GOSE).nnnRESULTSnPatients with full recovery had lower UCH-L1 concentrations on the second day and patients with favorable outcome had lower UCH-L1 concentrations during the first 2 days compared with patients with incomplete recovery and unfavorable outcome. Patients with full recovery and favorable outcome had significantly lower GFAP concentrations in the first 2 days than patients with incomplete recovery or unfavorable outcome. There was a strong negative correlation between outcome and UCH-L1 in the first 3 days and GFAP levels in the first 2 days. On arrival, both UCH-L1 and GFAP distinguished patients with GOS score 1-3 from patients with GOS score 4-5, but not patients with GOSE score 8 from patients with GOSE score 1-7. For UCH-L1 and GFAP to predict unfavorable outcome (GOS score ≤ 3), the area under the receiver operating characteristic curve was 0.727, and 0.723, respectively. Neither UCHL-1 nor GFAP was independently able to predict the outcome when age, worst Glasgow Coma Scale score, pupil reactivity, Injury Severity Score, and Marshall score were added into the multivariate logistic regression model.nnnCONCLUSIONSnGFAP and UCH-L1 are significantly associated with outcome, but they do not add predictive power to commonly used prognostic variables in a population of patients with TBI of varying severities.

The Levels of Glial Fibrillary Acidic Protein and Ubiquitin C-Terminal Hydrolase-L1 During the First Week After a Traumatic Brain Injury: Correlations With Clinical and Imaging Findings.

BACKGROUNDnGlial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase-L1 (UCH-L1) are promising biomarkers of traumatic brain injury (TBI).nnnOBJECTIVEnWe investigated the relation of the GFAP and UCH-L1 levels to the severity of TBI during the first week after injury.nnnMETHODSnPlasma UCH-L1 and GFAP were measured from 324 consecutive patients with acute TBI and 81 control subject enrolled in a 2-center prospective study. The baseline measures included initial Glasgow Coma Scale (GCS), head computed tomographic (CT) scan at admission, and blood samples for protein biomarkers that were collected at admission and on days 1, 2, 3, and 7 after injury.nnnRESULTSnPlasma levels of GFAP and UCH-L1 during the first 2 days after the injury strongly correlated with the initial severity of TBI as assessed with GCS. Additionally, levels of UCH-L1 on the seventh day after the injury were significantly related to the admission GCS scores. At admission, both biomarkers were capable of distinguishing mass lesions from diffuse injuries in CT, and the area under the curve of the receiver-operating characteristic curve for prediction of any pathological finding in CT was 0.739 (95% confidence interval, 0.636-0.815) and 0.621 (95% confidence interval, 0.517-0.713) for GFAP and UCH-L1, respectively.nnnCONCLUSIONnThese results support the prior findings of the potential role of GFAP and UCH-L1 in acute-phase diagnostics of TBI. The novel finding is that levels of GFAP and UCH-L1 correlated with the initial severity of TBI during the first 2 days after the injury, thus enabling a window for TBI diagnostics with latency.nnnABBREVIATIONSnAUC, area under the curveCI, confidence intervalED, emergency departmentGCS, Glasgow Coma ScaleGRAP, glial fibrillary acidic proteinIMPACT, International Mission for Prognosis and Clinical TrialROC, receiver-operating characteristicTBI, traumatic brain injuryTRACK-TBI, Transforming Research and Clinical Knowledge in Traumatic Brain InjuryUCH-L1, ubiquitin C-terminal hydrolase-L1.

The role of pre-hospital blood gas analysis in trauma resuscitation

BackgroundTo assess, whether arterial blood gas measurements during trauma patients pre-hospital shock resuscitation yield useful information on haemodynamic response to fluid resuscitation by comparing haemodynamic and blood gas variables in patients undergoing two different fluid resuscitation regimens.MethodsIn a prospective randomised study of 37 trauma patients at risk for severe hypovolaemia, arterial blood gas values were analyzed at the accident site and on admission to hospital. Patients were randomised to receive either conventional fluid therapy or 300 ml of hypertonic saline. The groups were compared for demographic, injury severity, physiological and outcome variables.Results37 patients were included. Mean (SD) Revised Trauma Score (RTS) was 7.3427 (0.98) and Injury Severity Score (ISS) 15.1 (11.7). Seventeen (46%) patients received hypertonic fluid resuscitation and 20 (54%) received conventional fluid therapy, with no significant differences between the groups concerning demographic data or outcome. Base excess (BE) values decreased significantly more within the hypertonic saline (HS) group compared to the conventional fluid therapy group (mean BE difference -2.1 mmol/l vs. -0.5 mmol/l, p = 0.003). The pH values on admission were significantly lower within the HS group (mean 7.31 vs. 7.40, p = 0.000). Haemoglobin levels were in both groups lower on admission compared with accident site. Lactate levels on admission did not differ significantly between the groups.ConclusionPre-hospital use of small-volume resuscitation led to significantly greater decrease of BE and pH values. A portable blood gas analyzer was found to be a useful tool in pre-hospital monitoring for trauma resuscitation.