Marilyn Johnson

Riding through red lights: The rate, characteristics and risk factors of non-compliant urban commuter cyclists

This study determined the rate and associated factors of red light infringement among urban commuter cyclists. A cross-sectional observational study was conducted using a covert video camera to record cyclists at 10 sites across metropolitan Melbourne, Australia from October 2008 to April 2009. In total, 4225 cyclists faced a red light and 6.9% were non-compliant. The main predictive factor for infringement was direction of travel, cyclists turning left (traffic travels on the left-side in Australia) had 28.3 times the relative odds of infringement compared to cyclists who continued straight through the intersection. Presence of other road users had a deterrent effect with the odds of infringement lower when a vehicle travelling in the same direction was present (OR=0.39, 95% CI 0.28-0.53) or when other cyclists were present (OR=0.26, 95% CI 0.19-0.36). Findings suggest that some cyclists do not perceive turning left against a red signal to be unsafe and the opportunity to ride through the red light during low cross traffic times influences the likelihood of infringement.

Safety in numbers? Investigating Australian driver behaviour, knowledge and attitudes towards cyclists

A key tenet of the safety in numbers theory is that as the number of people cycling increases, more drivers will also be cyclists and therefore will give greater consideration to cyclists when driving. We tested this theory in relation to self-reported behaviour, attitudes and knowledge in relation to cycling. An online survey was conducted of Australian drivers (n=1984) who were also cyclists (cyclist-drivers) and drivers who did not cycle (drivers). Cyclist-drivers were 1.5 times more likely than drivers to report safe driving behaviours related to sharing the roads with cyclists (95% CI: 1.1-1.9, p<0.01). Cyclist-drivers had better knowledge of the road rules related to cycling infrastructure than drivers; however knowledge of road rules related to bike lanes was low for both groups. Drivers were more likely than cyclist-drivers to have negative attitudes (e.g. cyclists are unpredictable and repeatedly overtaking cyclists is frustrating). Findings from this study highlight the need for increased education and awareness in relation to safe driving behaviour, road rules and attitudes towards cyclists. Specific recommendations are made for approaches to improve safety for cyclists.

Safer cycling in the urban road environment: study approach and protocols guiding an Australian study

Background Much of the research into cyclist safety in Australia has focused on behaviour with less focus on the impact of the urban transport environment on cyclist safety. A greater understanding of the urban transport system and the improvements needed to create a safer cycling environment are essential if cyclists are to be safe and increased cycling participation targets are to be achieved. The proposed study will use existing cyclist crash data along with unique cyclist exposure data to develop road infrastructure prototypes that improve cyclists’ safety and evaluate the effectiveness of these prototypes in a cycling simulator. Methods and design This study will be conducted in two Australian cities namely Perth and Melbourne as both cities have policies that strongly advocate cycling. Two methods of data collection will be employed: (1) in-depth crash investigations of injured cyclists; and (2) video footage of cyclist exposure through a naturalistic cycling study of non-injured cyclists. The findings from these two methods will be used to develop new urban road design prototypes which will be tested with a sample of cyclists and motorists in safe environment namely, a cycling simulator and a driving simulator. Discussion By designing and evaluating safer environments for cyclists, this study will identify solutions that reduce the risk of road trauma and importantly, support this alternative mode of transport and thereby contribute to a reduction in traffic-related emissions and pollution and enhance sustainable economic and social connectivity.

Bicycling crash characteristics: an in-depth crash investigation study

The aim of this study was to describe the crash characteristics and patient outcomes of a sample of patients admitted to hospital following bicycle crashes. Injured cyclists were recruited from the two major trauma services for the state of Victoria, Australia. Enrolled cyclists completed a structured interview, and injury details and patient outcomes were extracted from the Victorian State Trauma Registry (VSTR) and the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR). 186 cyclists consented to participate in the study. Crashes commonly occurred during daylight hours and in clear weather conditions. Two-thirds of crashes occurred on-road (69%) and were a combination of single cyclist-only events (56%) and multi-vehicle crashes (44%). Of the multi-vehicle crashes, a motor vehicle was the most common impact partner (72%) and distinct pre-crash directional interactions were observed between the cyclist and motor vehicle. Nearly a quarter of on-road crashes occurred when the cyclist was in a marked bicycle lane. Of the 31% of crashes that were not on-road, 28 (15%) occurred on bicycle paths and 29 (16%) occurred in other locations. Crashes on bicycle paths commonly occurred on shared bicycle and pedestrian paths (83%) and did not involve another person or vehicle. Other crash locations included mountain bike trails (39%), BMX parks (21%) and footpaths (18%). While differences in impact partners and crash characteristics were observed between crashes occurring on-road, on bicycle paths and in other locations, injury patterns and severity were similar. Most cyclists had returned to work at 6 months post-injury, however only a third of participants reported a complete functional recovery. Further research is required to develop targeted countermeasures to address the risk factors identified in this study.

In defence of mandatory bicycle helmet legislation: response to Hooper and Spicer

We invoke a triple rationale to rebut Hooper and Spicers argument against mandatory helmet laws. First, we use the laws of physics and empirical studies to show how bicycle helmets afford substantial protection to the user. We show that Hooper and Spicer erroneously downplay helmet utility and that, as a result, their attack on the utilitarian argument for mandatory helmet laws is weakened. Next, we refute their claim that helmet legislation comprises unjustified paternalism. We show the healthcare costs of bareheaded riding to pose significant third party harms. It follows, we argue, that a utilitarian case for helmet laws can be sustained by appeal to Mills Harm Principle. Finally, we reject Hooper and Spicers claim that helmet laws unjustly penalise cyclists for their own health-affecting behaviour. Rather, we show their argument to suffer by disanalogy with medical cases where injustice may be more evident, for example, denial of bypass surgery to smokers. We conclude that mandatory helmet laws offer substantial utility and are entirely defensible within the framework of a liberal democracy.

The impact of cognitive impairment in dementia on self-care domains in diabetes: A systematic search and narrative review

Self‐management is integral to effective chronic disease management. Cognitive impairments (CogImp) associated with dementia have not previously been reviewed in diabetes mellitus (DM) self‐care. The aims of this study are to know (1) whether CogImp associated with dementia impact self‐care and (2) whether specific CogImp affects key DM self‐care processes. A systematic literature search with a narrative review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. This review examined studies published from January, 2000 to February, 2016 describing the relationship between cognition and DM self‐care domains in community dwelling older adults with dementia/CogImp. Eight studies met inclusion criteria. Decrements in all self‐care domains were associated with CogImp. Problem solving was related to reduced disease knowledge (OR 0.87, 95% CI = 0.49‐1.55), resulting in poorer glycemic control. Decision‐making impairments manifested as difficulties in adjusting insulin doses, leading to more hospital admissions. People without CogImp were better able to find/utilize resources by adhering to recommended management (OR 1.03, 95% CI = 1.02‐1.05). A lack of interaction with health care providers was demonstrated through reduced receipt of important routine investigation including eye examinations (ARR = 0.85, 95% CI = 0.85‐0.86), HbA1c testing (ARR = 0.96, 95% CI = 0.96‐0.97), and LDL‐C testing (ARR = 0.91, 95% CI = 0.901‐0.914). People without CogImp had better clinic attendance (OR 2.17, 95% CI = 1.30‐3.70). Action taking deficits were apparent through less self‐testing of blood sugar levels (20.2% vs 24.4%, P = 0.1) resulting in poorer glycemic control, self‐care, and more frequent micro/macrovascular complications. Persons with diabetes and CogImp, particularly in domains of learning, memory and executive function, were significantly impaired in all self‐care tasks.

Unexplained absence resulting in deaths of nursing home residents in Australia-A 13-year retrospective study

To examine deaths of Australian nursing home (NH) residents following an unexplained absence.

Fatal road transport crashes among Australian residential aged care facility residents

To examine fatal road transport crashes of residential aged care facility (RACF) residents to determine crash characteristics and risk factors.

PW 1875 Do we already have the answers to prevent deaths on our roads? in-depth analysis of coroners’ recommendations

In Australia, all fatal transport crashes are investigated by Coroners. Detailed information on a range of factors generated for these investigations is not available elsewhere, yet to date, this data and the coroners’ recommendations are not being maximised to inform road safety policy and practice to reduce trauma on the roads. Further, the insights from these investigations are not being shared internationally to benefit road safety efforts globally. This study is a retrospective, descriptive study examining coroners’ recommendations from 2000 to 2017. During that period, there were over 24 000 deaths on Australian roads resulting in more than 2000 coroners’ recommendations to analyse. The recommendations are being examined in terms of: target population; risk/contributing factor; countermeasure; intervention level; implementation strategy; organisation, and; implementation timeframe. Analysis is currently underway. To date, fatalities involving vulnerable road users and heavy vehicle have been examined. In the main, the recommendations related vehicle modification (rear vision camera, warning technology for older style truck cabins with visibility restrictions) and education in relation to driver behaviour and expectation of vulnerable road users as well as public education about safe behaviour around heavy vehicles and visibility restrictions. Analysis is continuing and will include all road user types. Findings from this study will provide a systematic analysis of the medico-legal death investigations conducted for road deaths in Australia. It is anticipated that findings will contribute to the United Nation’s Sustainable Goal 11.2 to provide access to safe, affordable, accessible and sustainable transport systems as insights will be transferrable internationally.

188 Lessons from tragedy: an in-depth medico-legal examination of fatal road transport crashes

Background Every death on the road impacts the family, friends and relatives of the deceased as well as those people who were involved or witnessed the crash. In addition, there is a substantial economic cost of human loss. In Australia, the cost of road deaths from 2000 to 2014 is estimated at A