Rajiv A. Menon

The carnage wrought by major economic change: ecological study of traffic related mortality and the reunification of Germany

Abstract Objective: To document the effects of sudden economic change on death rates for occupants of cars in the former German Democratic Republic (East Germany). Design: Ecological time series study of East Germany in comparison with the formerFederal Republic of Germany (West Germany) before and after reunification in 1990. Setting: East and West Germany from 1985 to 1996 Subjects: Populations of East and West Germany between 1985 and 1996. Main outcome measures: Death rates for occupants of cars. Results:After the reunification of Germany, East Germany experienced a sudden, temporary affluence and a concomitant fourfold increase in death rates for car occupants between 1989and 1991.Although death rates increased in all age groups, young adults (aged 18-24) were most affected. The death rate per 100 000 population for those aged 18-20 years increased 11-fold between 1989 and 1991; for those aged 21-24 years the increase was eightfold. Conclusion: A tragic consequence of the reunification of Germany was a dramatic increase in the death rate for car occupants. Sudden economic change and availability of cars resulted in both a rise in vehicle ownership and an increase in the number of inexperienced drivers on roads that were ill prepared for the increased traffic. The lesson learnt from Germany is that during times of economic change and modernisation, measures to prevent the predictable injury deaths that will result need to be considered

The role of restraint and seat position in pediatric facial fractures

BACKGROUND Recently, head and brain injuries were identified as consequences of the inappropriate use of seat belts by children. The proposed mechanism of these injuries might also place a child at risk for facial fracture. METHODS A probability sample of children under age 16 involved in crashes were enrolled in an ongoing crash surveillance system (1998-2001) that links insurance claims data to telephone survey and crash investigation data (unweighted, n = 12,659; weighted, n = 131,717). Incidence of facial fracture was estimated and a series of cases were examined using in-depth crash investigation to identify the mechanisms of these injuries, specifically, the role of seating position and restraint use in the mechanism of injury. RESULTS Ninety-two children suffered a fracture of the facial bones (0.07% of all children in crashes). Among restrained children with facial fractures (n = 68), those inappropriately restrained were at a 1.6-fold higher risk (95% confidence interval, 1.2-2.1; p = 0.001) of significant injury than those appropriately restrained for their age. The in-depth investigations revealed that excessive head excursion resulting from suboptimal torso restraint caused facial impact, which resulted in the facial injuries described. CONCLUSION The potential for disfigurement associated with these facial injuries may resonate strongly with parents, and prevention of disfigurement may provide additional motivation for proper restraint, in particular, booster seats and rear seat location, for this pediatric population.

Backing collisions: a study of drivers' eye and backing behaviour using combined rear-view camera and sensor systems

Context Backing crash injures can be severe; approximately 200 of the 2,500 reported injuries of this type per year to children under the age of 15 years result in death. Technology for assisting drivers when backing has limited success in preventing backing crashes. Objectives Two questions are addressed: Why is the reduction in backing crashes moderate when rear-view cameras are deployed? Could rear-view cameras augment sensor systems? Design 46 drivers (36 experimental, 10 control) completed 16 parking trials over 2  days (eight trials per day). Experimental participants were provided with a sensor camera system, controls were not. Three crash scenarios were introduced. Setting Parking facility at UMass Amherst, USA. Subjects 46 drivers (33 men, 13 women) average age 29 years, who were Massachusetts residents licensed within the USA for an average of 9.3  years. Interventions Vehicles equipped with a rear-view camera and sensor system-based parking aid. Main Outcome Measures Subjects eye fixations while driving and researchers observation of collision with objects during backing. Results Only 20% of drivers looked at the rear-view camera before backing, and 88% of those did not crash. Of those who did not look at the rear-view camera before backing, 46% looked after the sensor warned the driver. Conclusions This study indicates that drivers not only attend to an audible warning, but will look at a rear-view camera if available. Evidence suggests that when used appropriately, rear-view cameras can mitigate the occurrence of backing crashes, particularly when paired with an appropriate sensor system.