Giulia Scime

Injury prevention in child death review: child pedestrian fatalities

Objective This article describes the epidemiology of child pedestrian fatalities in British Columbia using data generated by the provinces Child Death Review Unit, to demonstrate the unique capacity of child death review to provide an ecological understanding of child mortality and catalyse evidence based, multi-level prevention strategies. Methods All child pedestrian fatalities in British Columbia from 1 January 1 2003 to 31 December 2008 were reviewed. Data on demographics, circumstance of injury, and risk factors related to the child, driver, vehicle, and physical environment were extracted. Frequency of sociodemographic variables and modifiable risk factors were calculated, followed by statistical comparisons against the general population for Aboriginal ancestry, gender, ethnicity, income assistance and driver violations using z and t tests. Results Analysis of child pedestrian fatalities (n=33) found a significant overrepresentation of Aboriginal children (p=0.06), males (p<0.01), and children within low income families (p<0.01). The majority of incidents occurred in residential areas (51.5%), with a speed limit of 50 kph or higher (85.7%). Risky pedestrian behaviour was a factor in 56.7% of cases, and 33% of children under 10 years of age were not under active supervision. Drivers had significantly more driving violations than the comparison population (p<0.01). Conclusion Child pedestrian fatalities are highly preventable through the modification of behavioural, social, and environmental risk factors. This paper illustrates the ability of child death review to generate an ecological understanding of injury epidemiology not otherwise available and advance policy and programme interventions designed to reduce preventable child mortality.

Effectiveness of cataract surgery in reducing driving-related difficulties: a systematic review and meta-analysis.

Objectives: To assess the effects of cataract surgery in improving vision and driving performance while reducing driving-related difficulties. Design: Systematic review and meta-analysis. Data sources: Twelve electronic databases were searched from the date of inception of each database to May 2007. Other sources of potentially relevant information were also identified and examined. Review methods: Eligible study designs included randomized controlled trials (RCT), non-RCT, quasi-experimental, case-control, controlled-before-and-after, and cohort studies that examined driving-related indicators in patients undergoing cataract surgery. Main outcome measures: The outcome measures included any type of driving-related indicator. A secondary outcome measure was motor vehicle (MV) crash involvement. Results: Seven studies were included in the review and five in the meta-analysis. The overall pooled odds ratio (OR) was 0.12 (95% CI 0.10 to 0.16). Results suggest that the risk of driving-related difficulties was reduced by 88% following cataract surgery. Conclusions: Cataract surgery is associated with an 88% reduction in the risk of driving-related difficulties. This supports the efficacy of cataract surgery to improve driving in older people, as well as positive implications for a reduction in MV crashes, overall traffic safety, and individual well-being.

Impact of lowering the legal blood alcohol concentration limit to 0.03 on male, female and teenage drivers involved alcohol-related crashes in Japan

In June of 2002, a revision to part of the Road Traffic Act drastically increased the penalties for drinking and driving offences in Japan. Most notably, the legal blood alcohol concentration (BAC) limit for driving was lowered from 0.05 mg/ml to 0.03 mg/ml. The rationale for the new lower BAC limit was predicated on the assumption that drinking drivers will comply with the new, lower limit by reducing the amount of alcohol they consume prior to driving, thereby lowering their risk of crash involvement. This, in turn, would lead to fewer alcohol-related crashes. A key limitation of previous lower BAC evaluation research in determining the effectiveness of lower legal BAC limit policies is the assumption of population homogeneity in responding to the laws. The present analysis is unique in this perspective and focuses on the evaluation of the impact of BAC limit reduction on different segments of the population. The chief objective of this research is to quantify the extent to which lowering the legal limit of BAC has reduced male, female and teenager involvement in motor vehicle crashes in Japan since 2002. Most notably, the introduction of reduced BAC limit legislation resulted in a statistically significant decrease in the number of alcohol-impaired drivers on the road in Japan, indicating responsiveness to the legal change among adults and teenagers. In addition, this preliminary assessment appears to indicate that the implementation of 0.03 BAC laws and other associated activities are associated with statistically significant reductions in alcohol-involved motor vehicle crashes. In comparison, the rates of total crashes showed no statistically significant decline nor increase in the period following the introduction of the BAC law, indicating that the lower BAC limit only had an effect on alcohol-related crashes in Japan. The evidence suggests that the lower BAC legal limit and perceived risk of detection are the two most important factors resulting in a sustained change in drinking and driving behaviour in Japan. It is recommended that future research and resources in other countries be focused on these factors as determinants to reduced alcohol-related crashes.

Sociodemographic Factors Associated With Aggressive Driving Behaviors of 3-Wheeler Taxi Drivers in Sri Lanka

Little is known about the nature and scope of aggressive driving in developing countries. The objective of this study is to specifically examine the sociodemographic factors associated with aggressive driving behavior among 3-wheeler taxi drivers in Sri Lanka. Convenience samples of 3-wheeler taxi drivers from Rathnapura, Ahaliyagoda, Sri Lanka were surveyed from June to August 2006. Analyses included bivariate and multivariate logistic regression. Drivers with less than high school education were 3.5 times more likely to drive aggressively (odds ratio [OR] = 3.46; 95% confidence interval [CI] = 1.08, 11.1). Single drivers were 9 times more likely to run red lights (OR = 8.74; 95% CI = 2.18, 35.0), and being single was a major risk factor for drunk driving (OR = 4.80; 95% CI = 1.23, 18.7). Furthermore, high school completers were 4 times more likely to bribe a policeman (OR = 4.27; 95% CI = 1.23, 14.9) when caught violating the road rules. Aggressive driving and risk-taking behavior are amenable to policy initiatives, and preventive programs targeted at key groups could be used to improve road safety in Sri Lanka. This study demonstrates that aggressive driving behavior is associated with sociodemographic factors, including the level of education, marital status, and other socioeconomic factors. Hence, economic factors should be addressed to find solutions to traffic-related issues. It will be the government’s and policy makers’ responsibility to try and understand the economic factors behind risky road behavior and bribe-taking behavior prior to legislating or enforcing new laws.

Compulsory child restraint seat law and motor vehicle child occupant deaths and injuries in Japan 1994-2005

The purpose of child restraint seats (CRS) is to reduce the number of individuals killed or injured in motor vehicle (MV) crashes. Japanese Road Traffic Law 17–3-4 (April 2000) specifies a requirement that CRS be used for all children aged 0–5 years. The objective of this evaluation was to determine the legislative impact on fatalities in Japan for the period 1994–2005. Data were obtained from the Institute for Traffic Accident Research and Data Analysis. A time-series Poisson regression model was used to analyse the change (6 years pre/post) in incidence rate ratios of fatality and injury in MV crashes among children ages 0–5 years. Despite increases in CRS use, fatalities failed to decrease significantly after enactment of the law (incidence rate ratio: 0.80; 95% CI: 0.49–1.31). In 2005, 67% of children aged 0–5 years, who were killed as MV occupants were not seated in CRS. Between 2000 and 2005, the lack of CRS led to 43% of front seat passenger deaths, 54% of rear seat deaths, 143 children died in total and 500 + children were seriously injured. It was found that the compulsory CRS law enacted in April 2000 did not result in a statistically significant reduction in child MV occupant fatalities and injuries in Japan.

Youth injuries in British Columbia: type, settings, treatment and costs, 2003-2007.

In this study, the types and costs of unintentional injuries among adolescents transitioning to adulthood are examined to provide age-appropriate prevention strategies. The data were collected in 2003, 2005 and 2007, in which a total of 273 (41%), 228 (39%) and 176 (33%) youths, respectively, reported to be having at least one serious injury. The leading types of injuries were sprains/strains, broken bones and bruises. Most injuries occurred while playing sports, falling/tripping, biking or rollerblading, mainly in recreation centres (>12–15%), schools (<27–9%), and workplaces (>2–14.5%). Most injuries were treated at emergency departments, walk-in clinics and health professionals offices (68–84%). Prevention included: doing nothing; being more careful; giving up the activity and rarely, rehabilitation or physiotherapy. The total direct cost of treatment was

Prevention of baby-walker-related injury

471,498, (Canadian) at a mean direct cost of

Bull Bars and Vulnerable Road Users

775 per injury. Improved sports training and educational strategies targeted at subgroups of adolescents are needed to reduce the human and economic burden of injury.

Cost effectiveness of cataract surgery

www.thelancet.com Vol 373 February 14, 2009 545 simply be scaled up” is perplexing. There is ample evidence of successful communication and behaviourchange campaigns—eg, Thailand’s “100% condom” and Uganda’s “zerograzing” campaigns. More recently, Swaziland scaled up a boldly successful campaign to address multiple and concurrent partnerships. It certainly was not our intention to promote “non-participatory, noncon sultative interventions”. Although urging that “knowing your epidemic” should be a primarily scientifi c endeavour, we also repeatedly emphasised the “need to address imme diate risk settings as well as social norms.” Finally, the assertion that a “revitalised HIV prevention movement needs to move beyond... whether any specifi c intervention is more important than the other” is problematic. Eff ective public health must be grounded in evidence and prioritise what is most eff ective. Although the general notion of “comprehensive pre vention” is appealing, the specifi c elements of the mix are essential. The assumption that merely combining diff erent strategies—whose individual eff ectiveness is often “insuffi ciently proven”—will some how result in a sub stantial population-level eff ect is dubious. As with HIV treatment regimens, prevention elements should be combined, but their combined eff ectiveness must be demonstrated. Trials of standard combination prevention approaches in Africa have thus far been unsuccessful (and, in one, HIV incidence was higher in the experimental group). Like treatment, prevention must be deployed with scientifi c rigour.

Are 1994 alcohol production and the sales deregulation policy in Japan associated with increased road traffic fatalities among adult and teenage males and females in Japan

Objectives: Pedestrian injuries are a leading cause of the global death and injury burden, accounting for 65 percent of the 1.2 million annual road deaths. The purpose of this brief literature review is to examine whether bull bars, a rigid aftermarket accessory fitted to the front end of passenger vehicles, increase the risk of severe and fatal injuries to vulnerable road users in the event of a collision. Methods: Applicable peer-reviewed research, review papers, and grey literature were identified from a search of MEDLINE; the Transportation Research Board (TRB) database composed of Transportation Research Information Services (TRIS) and International Transport Research Documentation (TRID) databases; the Cochrane Database of Systematic Reviews; and Google Scholar. The following search terms were used: “bull bars” OR “nudge bars” OR “sahara bars” AND “pedestrians” OR “vulnerable road users” for 1948 to March 1, 2011. A secondary set of search terms was also included “bull bars” OR “nudge bars” OR “sahara bars” OR “vehicle frontal protective systems” AND “pedestrians” OR “vulnerable road users” for 1948 to March 1, 2011. Results: Neither the MEDLINE search nor the Cochrane Review search returned any relevant literature. The TRID search returned 19 research articles, 9 of which were included. Searches using Google Scholar returned 110 items, of which 21 were included in the present review after excluding patents and citations. Seven of the articles from TRID were also found in the Google Scholar search, resulting in 23 unique articles being included in this review. The studies used included 12 real-world studies, 3 computer modeling studies, and 8 laboratory testing studies. Very few studies examined the road safety of pedal-cyclists and motorcyclists; therefore, we focused solely on studies examining pedestrian safety. Conclusions: The literature reviewed in this study indicates that vehicles fitted with bull bars, particularly those without deformable padding, concentrate crash forces over a smaller area of vulnerable road users during collisions compared to vehicles not fitted with a bull bar. Rigid bull bars, such as those made from steel or aluminum, stiffen the front end of vehicles and interfere with the vital shock absorption systems designed in vehicle fronts. These devices therefore significantly alter the collision dynamics of vehicles, resulting in an increased risk of pedestrian injury and mortality in crashes. This literature review shows that bull bars do indeed increase the severity of injuries to vulnerable road users in the event of a collision and highlights the need for current traffic safety policies to reflect the safety concerns surrounding the use of bull bars.