Scenarios of crashes involving light mopeds on urban bicycle paths.

In the Netherlands, cyclists have to share the bicycle path with light moped riders. These riders are allowed to ride 25 km/h and do not have to wear a helmet (Dutch regulation). Due to several trends such as traffic congestion and the introduction of the scooter model, light mopeds have become more popular, both among older and younger people. This has led to an increased traffic density on bicycle paths as well as concerns about the safety of cyclists. In response to these concerns, several Dutch cities would like to ban light moped riders (LMRs) from the bicycle path and let them ride on the carriageway. However, it is uncertain what the consequences would be for the safety of light moped riders. Moreover, it is not clear to what extent the shared use of bicycle paths leads to serious crashes between cyclists and LMRs. Therefore, an in-depth crash investigation study was carried out to gain more insight into the factors and circumstances that influence the occurrence and consequences of light moped crashes on bicycle paths. A dedicated team for in-depth road crash investigation collected and analyzed detailed information on 36 light moped crashes that occurred on an urban bicycle path. This resulted in a description of the course of events for every crash that was analyzed, including a list of factors that contributed to the occurrence of the crash and possible injuries. Crashes with a similar course of events and a comparable combination of contributory factors were grouped into (sub)types of light moped crashes. Six types of crashes were identified. Based on the contributory crash factors of the identified crash types, remedial measures can be developed to prevent similar crashes from occurring in the future. Moving the LMR to the carriageway is only advisable on 30 km/h roads. Alternative measures to improve the safety of both cyclists and light moped riders include: 1) removing obstacles such as poles from the bicycle path, 2) following guidelines on the minimum width of bicycle paths given traffic volumes, 3) improving sight distances at intersections, 4) traffic light control without conflicts between traffic flows, and 5) introducing a helmet law for light moped riders and their passengers.

The MMSE should not be the sole indicator of fitness to drive in mild Alzheimer's dementia.

Since Alzheimer's disease may affect driving performance, patients with Alzheimer's disease are assessed on fitness to drive. On-road driving assessments are widely used, and attempts have also been made to develop strategies to assess fitness to drive in a clinical setting. Preferably, a first indication of fitness to drive is obtained quickly after diagnosis using a single test such as the Mini-Mental State Examination (MMSE). The aim of this study is to investigate whether the MMSE can be used to predict whether patients with Alzheimer's disease will pass or fail an on-road driving assessment. Patients with Alzheimer's disease (n = 81) participated in a comprehensive fitness-to-drive assessment which included the MMSE as well as an on-road driving assessment [PLoS One 11(2):e0149566, 2016]. MMSE cutoffs were applied as suggested by Versijpt and colleagues [Acta Neurol Belg 117(4):811-819, 2017]. All patients with Alzheimer's disease who scored below the lower cutoff (MMSE ≤ 19) failed the on-road driving assessment. However, a third of the patients with Alzheimer's disease who scored above the upper cutoff (MMSE ≥ 25) failed the on-road driving assessment as well. We conclude that the MMSE alone has insufficient predictive value to correctly identify fitness to drive in patients with very mild-to-mild Alzheimer's disease implicating the need for comprehensive assessments to determine fitness to drive in a clinical setting.

Crashes involving cyclists aged 50 and over in the Netherlands: An in-depth study.

The number of seriously injured cyclists is increasing in the Netherlands. The majority of these seriously injured cyclists were involved in single-bicycle or bicycle-bicycle crashes. Little is known about the circumstances in which these crashes occur, as the police only registers 4% of these crashes. Therefore, an in-depth study was carried out to gain insight into the factors and circumstances that influence the occurrence and consequences of these crashes. The focus was on crashes involving cyclists aged 50 and over, as this group has a large share in the number of cyclist-only crashes. Detailed information on 41 single-bicycle and bicycle-bicycle crashes was collected and analysed. This resulted in a description of the course of events for every analysed crash, including a list of factors that had contributed to the occurrence of the crash and possible injuries. Subsequently, crashes with a similar course of events and a comparable combination of contributory factors were grouped into types of crashes. Results showed that cyclists aged 75 and over are more often involved in falls from a bicycle than younger cyclists. Contributory factors that played a role in a large number of crashes were behaviour of another road user, distraction and narrow cycling facilities or traffic lanes. However, which factors played a role in the occurrence of a crash depended on the type of crash. Eight types of crashes were identified. Based on the factors that played a role in the occurrence of these crashes, remedial measures can be developed to prevent similar crashes from occurring in the future.

Effects of incentive programs to stimulate safety belt use: a meta-analysis.

The effects of campaigns using tangible incentives (rewards) to promote safety belt usage have been evaluated by means of a meta-analytic approach. Two coders extracted a total number of 136 short-term and 114 long-term effect sizes and coded many other variables from 34 journal articles and research reports. The results show a mean short-term increase in use rates of 20.6 percentage points; the mean long-term effect was 13.7 percentage points. Large scale studies report smaller effect sizes than small scale studies; when studies were weighted by the (estimated) number of observations, the weighted mean effect sizes were 12.0 and 9.6 percentage points for the short and long term, respectively. The main factors that influence the magnitude of the reported short-term effect of the programs were the initial baseline rate (which was highly correlated with the presence or absence of a safety belt usage law), the type of population involved, whether incentives were delivered immediately or delayed, and whether incentives were based on group or individual behaviour. Together these four variables accounted for 64% of the variance. Other variables, such as the duration of the intervention, the probability of receiving a reward, and the value of the reward were not related to the short-term effect sizes. The relationship between moderating variables and long-term effects was less clear.