Hans-Yngve Berg

Accident involvement among learner drivers—an analysis of the consequences of supervised practice

It is a well-known fact that experience is important for safe driving. Previously, this presented a problem since experience was mostly gained during the most dangerous period of driving-the first years with a licence. In many countries, this experience paradox has been addressed by providing increased opportunities to gain experience through supervised practice. One question, however, which still needs to be answered is what has been lost and what has been gained through supervised practice. Does this method lead to fewer accidents after licensing and/or has the number of accidents in driving practice increased? There were three aims in the study. The first was to calculate the size of the accident problem in terms of the number of accidents, health risk and accident risk during practising. The second aim was to evaluate the solution of the experience paradox that supervised practice suggests by calculating the costs in terms of accidents during driving practice and the benefits in terms of reduced accident involvement after obtaining a licence. The third aim was to analyse conflict types that occur during driving practice. National register data on licence holders and police-reported injury accidents and self-reported exposure were used. The results show that during the period 1994-2000, 444 driving practice injury accidents were registered, compared to 13657 accidents during the first 2 years with a licence. The health risk during the period after licensing was 33 times higher and the accident risk 10 times higher than the corresponding risk during practice. The cost-benefit analysis showed that the benefits in terms of accident reduction after licensing were 30 times higher than the costs in terms of driving practice accidents. It is recommended that measures to reduce such accidents should focus on better education of the lay instructor, but not on introducing measures to reduce the amount of lay-instructed practice.

Reducing crashes and injuries among young drivers: what kind of prevention should we be focusing on?

Every year, drivers throughout the world are killed or injured in road traffic. Young drivers run a greater risk everywhere, and this problem is still largely unsolved. Better understanding of the underlying processes could, however, be a useful tool in preventive endeavours. To change a young driver’s goals behind driving and the context in which it is done, a variety of different methods of persuasion should be tested. Both “soft” and “hard” methods should be used. For example, communication and increased enforcement may be used simultaneously. Communication campaigns should highlight the dangers of unsafe behaviour and in particular target young males. Communication campaigns that employ persuasive, emotional messages are most effective where young drivers are concerned. Research shows that attitudes about safety are formed at an early age, long before legal driving, and therefore it would also be important to target young adolescents. Laws need enforcement to be effective and should target areas of particular risk to young drivers. Driver education or communication campaigns cannot be expected to radically change a young person’s life goals. For that purpose, active learning methods that make use of the learner’s own experiences have to be applied. Special courses for young drivers designed to make individuals conscious of their personal tendencies and the type of social context that affects their driving behaviour could be helpful, whether offered via the ordinary school system or at driving schools.

Typical patterns in road-traffic accidents during driver training: An explorative Swedish national study

A new law came into force in Sweden on 1 September 1993, which makes instructor-assisted driving practice possible at the age of 16 years instead of the previous 17 years and 6 months. When the age limit was reduced, the possibility that this would lead to more road-traffic accidents (RTA) during driving practice was discussed. The aim of this study was to highlight typical road-traffic accident patterns and to discuss their potential for improved training and targeted prevention. A total of 11 variables (41 categories) descriptive of the 1081 RTA involving novice drivers and police registered during the period 1994-1999 were analysed simultaneously using in turn, two multivariate analysis techniques: the Factorial Analysis of Correspondence (FAC) and the Hierarchical Ascendant Classification (HAC). Four accident classes were identified and quantified, of which the first two were more typical of rural areas: (1). accidents in rural areas on straight stretches and related to speed limit 70 km/h (n = 306); (2). accidents in rural areas on straight stretches and high-speed related (n = 97); (3). accidents in built-up areas, low-speed related and of the type rear-end (n = 289); and (4). accidents in built-up areas, at road junctions and low-speed related (n = 380). Together, these classes point to a variety of opportunities to develop ways of working with targeted prevention. Instead of adopting a general attempt to counteract the relationship between individual variables and accidents, it is possible instead to focus on a whole context and its relationship with its typical accidents and any resulting injuries. This, in its turn, allows greater specificity in the build up of the Swedish licence and training regulations and its corresponding course curriculum.

A pattern analysis of traffic crashes fatal to older drivers

A synthesis of the various crash circumstances in which older drivers die is lacking. This study is based on data from Swedens national archive of fatal RTCs, and focuses on crashes in which the deceased driver was aged 65+ (2002-2004; n=152). Crash patterns were identified by means of cluster analysis using a sub-set of 12 variables describing both driver and crash event characteristics. Crashes where the driver had died of natural causes prior to crash made up 19.7% of the cases (30 crashes) and were mainly single crashes. Four additional clusters were also identified. Two involved making left turns at intersections, one over-represented among men, occurring typically at weekends, in low-speed areas (30.6%), and the second one, over-represented among women, consisting of crashes in dry road conditions, and on intermediate-speed roads (21.5%). A third cluster included head-on and single-vehicle crashes occurring in dry road conditions but on high-speed roads (29.8%). The last cluster consisted of crashes occurring during the winter and on high-speed roads (18.2%). Older drivers die in traffic in various circumstances, sometimes prior to crashing. Some circumstances cannot be easily alleviated but others could, e.g., through modifications of the road traffic environment and car active safety measures that can help compensate for age-related shortcomings.

LEARNER DRIVERS AND LAY INSTRUCTION - HOW SOCIO-ECONOMIC STANDING AND LIFESTYLE ARE REFLECTED IN DRIVING PRACTICE FROM THE AGE OF 16

On September 1st 1993, a new law came into effect in Sweden, permitting instructor-supported driving practice from the age of 16 instead of 17 years and 6 months. The intention was to enable young ...

Analgesics and road traffic crashes in senior drivers: An epidemiological review and explorative meta-analysis on opioids

AIMnTo assess the epidemiological evidence associating the use of analgesics with the occurrence of road traffic crashes in senior drivers including a meta-analysis with specific focus on opioids.nnnMETHODSnSystematic literature review of articles published between 1991 and 2012 retrieved from major databases using relevant key words. Eligible articles were fully reviewed and the main characteristics and results summarized. The methodological quality was assessed using the Newcastle-Ottawa Scale. Heterogeneity tests and forest and funnel plots were used as part of the meta-analysis on opioids.nnnRESULTSnFrom the potentially eligible articles, nine were selected (4 case-control, 1 case-crossover, and 4 cohort studies) of which four were of medium and five of high quality; seven investigated opioids and four non-steroidal anti-inflammatory drugs. Crash involvement (n=7) rather than responsibility (n=2) was investigated. Age and sex were the most common covariates adjusted for. Both opioids and non-steroidal anti-inflammatory drugs showed mixed results including differences across estimates between and within studies. A marginal positive effect was observed in the pooled analyses on opioids (n=6, OR 1.20; 95% CI 1.08-1.32).nnnCONCLUSIONSnThe evidence is unconvincing in terms of number of studies, control of major confounders, and consistency of the results. The effect seen for opioids can be attributed to the lack of adjustment of key confounders such as concomitant illness or the consumption of alcohol or other psychoactive medications. There is a need for more efficient designs like larger population-based retrospective cohorts and nested case-control or case-crossover studies based on registers of high quality allowing adjustment for these factors and for the selection of unequivocal outcomes (e.g. drivers responsibility) to produce more persuasive empirical evidence.

Quality of life following road traffic injury: A systematic literature review

PURPOSEnTo assess and provide a systematic overview of current knowledge about the relationship between quality of life (QoL) and road traffic injury, and to appraise how QoL is affected by road traffic injury.nnnMETHODSnA systematic review of the literature published since 1990 on QoL after a road traffic injury, including adult and paediatric populations, from three databases (Pubmed, PsychInfo and SafetyLit) was undertaken. The methodological quality was assessed according to the Newcastle-Ottawa Quality Assessment Scale.nnnRESULTSnThirty articles were included and assessed for quality. The QoL scores of those injured were similar to population norms at the first assessment, followed by a drop at the second assessment. An increase of QoL from the second to third assessment was reported, but participants never reached the population norms at the last follow-up (range six weeks to two years), with an exception of those claiming compensation and those with lower extremity fractures. Age, gender, socioeconomic status, injury severity, injury type and post-traumatic stress disorder were associated with reduced QoL.nnnCONCLUSIONSnAvailable literature regarding QoL among injured in road traffic crashes is heterogeneous with regard to aims and tools used for assessment. Our review confirmed that independent of measure, the overall QoL was significantly reduced after a road traffic injury compared to the general population norms. Persons who are older, of female gender, lower socioeconomic status, diagnosed with post-traumatic stress disorder, with more severe injuries or injuries to the lower limbs are more vulnerable to loss of QoL following road traffic injury compared to other patient groups injured in road traffic crashes.

I did NOT feel like this at all before the accident: do men and women report different health and life consequences of a road traffic injury?

Background Worldwide, injuries represent one of the leading causes of mortality, and nearly one-quarter of all injuries are road traffic related. In many high-income countries, the burden of road traffic injuries (RTIs) has shifted from premature death to injury and disability with long-term consequences; therefore, it is important to assess the full burden of an RTI on individual lives. Objective To describe how men and women with minor and moderate injuries reported the consequences of an RTI on their health and lives. Methods The study was designed as an explorative qualitative study, in which the answers to an open-ended question concerning the life and health consequences following injury were analysed using systematic text condensation. Participants A total of 692 respondents with a minor or a moderate injury were included. Results The respondents reported the consequences of the crash on their health and lives according to four categories: physical consequences, psychological consequences, everyday life consequences and financial consequences. The results show that medically classified minor and moderate injuries have detrimental long-term health and life consequences. Although men and women report some similar consequences, there are substantial differences in their reported psychological and everyday life consequences following an injury. Women report travel anxiety and PTSD-like symptoms, being life altering for them compared with men, for whom these types of reports were missing. Conclusion These differences emphasise the importance of considering gender-specific physical and psychological consequences following an RTI.

Measuring and assessing risk of quality of life loss following a road traffic injury: A proposed methodology for use of a composite score

INTRODUCTIONnAssessments of the impact of road traffic injuries (RTIs) on quality of life (QoL) can benefit from the use of combined characteristics of the injurious event.nnnAIMnThe burden of having sustained a RTI was computed using a composite score that comprised three elements (i.e. number of injuries sustained in the crash, body parts affected, and severity of the injuries) that relate to the probability of subsequent long-term QoL lost by individuals 1-4 years after the crash.nnnMETHODOLOGYnThe QoL of injured victims aged 11-90 years that crashed in Sweden between 2007 and 2009 was compared with that of a random sample of non-injured individuals frequency-matched by sex and age. Injury information to build the composite score was obtained from a national register that contains data on the number of injuries, their severity, and the body parts affected. The QoL was assessed in 2010 for both injured and non-injured individuals using the standardized Euro Quality of Life questionnaire. Logistic regression was used to investigate whether the composite score was predictive of low QoL (<90% of the mean of non-injured referents) adjusting for sex, age, and time elapsed since the injury occurrence. The composite score was grouped into five exposure categories (0.01-1, 1.01-1.5, 1.51-2, 2.01-3 and 3.01-9 units).nnnRESULTSnCompared with the non-injured reference group, all exposure categories showed statistically significant increased adjusted ORs for low QoL ranging from 2.35 (95% CI 1.48-3.72) in the 0.01-1.00 lowest injury category to 6.10 (95% CI 3.65-10.2) in the highest 3.01-9.00 with a slightly decreasing plateau in the intermediate categories (point ORs between 3.86 and 3.06). Yet, all 95% CIs across the exposure categories overlapped.nnnCONCLUSIONnLong-term reduction in QoL is a burden experienced by the victims of mild to severe RTCs. The proposed composite score can be an initial step in the development of more elaborated instruments that can be useful in policy making and regulation.