Crash severity analysis: A data-enhanced double layer stacking model using semantic understanding.

The crash severity analysis is of significant importance in traffic crash prevention and emergency resource allocation. A range of innovations offers potential traffic crash severity prediction models to improve road safety. However, the semantic information inherent in traffic crash data, which is crucial in enabling a deeper understanding of its underlying factors and impacts, has yet to be fully utilized. Moreover, traffic crash data are commonly characterized by a small sample size, which leads to sample imbalance problem resulting in prediction performance decline. To tackle these problems, we propose a semantic understanding-based data-enhanced double-layer stacking model, named EnLKtreeGBDT, for crash severity prediction. Specifically, to fully leverage the inherent semantic information within traffic crash data and analyze the factors influencing crashes, we design a semantic enhancement module for multi-dimensional feature extraction. This module aims to enhance the understanding of crash semantics and improve prediction accuracy. Then we introduce a data enhancement module that utilizes data denoising and migration techniques to address the challenge of data imbalance, reducing the prediction model's dependence on large sample crash data. Furthermore, we construct a two-layer stacking model that combines multiple linear and nonlinear classifiers. This model is designed to augment the capability of learning linear and nonlinear mixed relationships, thereby improving the accuracy of predicting the severity of crashes on complex urban roads. Experiments on historical datasets of UK road safety crashes validate the effectiveness of the proposed model, and superior performance of prediction precision is achieved compared with the state-of-the-arts. The ablation experiments on both semantic and data enhancement modules further confirm the indispensability of each module in the proposed model.

Road Traffic Injuries in South Africa: A Complex Global Health Crisis.

1.3 million people die each year as a result of Road traffic crashes. Road Traffic Injuries are a global health crisis with 90% of global deaths affecting LMICs. Sustainable Development Goal 3.6 focuses on reducing road injury and death. The global plan is based on the Safe Systems approach. In South Africa, the burden of crashes on the health system and society is particularly high with a population death rate of 20.7 per 100 000 population. Understanding local context and culture is critical. Rurality, distorted urban planning, higher travel exposure and alcohol usage disproportionately impact racial and ethnic minorities. Pedestrian safety is a key priority. There is a critical need for the global health community to take an active role in advocacy in order to achieve SDG 3.6 by 2030.

Characteristics of injuries related to traffic crashes in Israel before and during the COVID-19 pandemic.

OBJECTIVES: This study explored differences in patient characteristics, injury characteristics, treatment modalities, and treatment outcomes among patients who presented to the Emergency Department (ED) following traffic crashes during the COVID-19 period (from March 15, 2020 to March 15, 2022) in comparison to the previous corresponding period between 2017 and 2019. METHODS: The study is a retrospective chart review study. The study included a random sample of 610 patients who presented to the ED of a major hospital located in northern-central Israel following traffic crashes: 305 patients who presented during the COVID-19 period (from March 15, 2020 to March 15, 2022) and 305 patients who presented during the previous corresponding period (from March 15, 2017 to March 15, 2019). Socio-demographic data, data regarding the traffic crashes, and medical data of the patients were collected from their medical records, and the data were compared. RESULTS: In the context of the COVID-19 period, a notable surge in the percentage of cyclist victims was evident, marking an increase from 7.5% to 19% compared to the corresponding period. Conversely, the incidence of pedestrian victims during the COVID-19 period dropped to 19.7%, in contrast to 30.8% in the corresponding period. Notably, patients involved in pedestrian crashes amid the COVID-19 period exhibited a shorter hospital stay (M = 2.8 days, SD = 3.3) compared to the corresponding period (M = 4.3 days, SD = 7.1) [t = 1.8 (df = 141), p < 0.05]. However, a higher fatality rate was observed among these patients during the COVID-19 period compared to the corresponding period (6.7% vs. 0%) [χ2 = 6.4 (df = 1), p < 0.05]. CONCLUSIONS: The study reveals significant changes in traffic crashes characteristics during the pandemic period, including a notable increase in cyclist victims and a decrease in pedestrian incidents. These shifts may be attributed to factors such as changes in transportation patterns, increased use of bicycles for essential travel. Despite these changes, the proportion of severe crashes remained relatively consistent. These findings underscore the importance of understanding the underlying causes behind these shifts and highlight the ongoing need for public education and awareness initiatives to promote traffic safety, particularly for vulnerable road users, during pandemic periods.

The effectiveness of regulations preventing alcohol-related road traffic crashes and fatalities in the European Union countries.

INTRODUCTION: This article addresses the impact of policy measures on the number of alcohol-related crashes and fatalities in European Union countries. In particular, it assesses (1) whether mild or severe penalty measures should be used to reduce the number of crashes and fatalities caused by alcohol; and (2) whether alcoholic beverages should be treated differently or proportionally to their alcohol content. METHODS: This study analyzed the number of alcohol-related crashes and fatalities in 24 European Union countries between 2002 and 2014. The methodology involved fixed-effects panel models, models with instrumental variables, the Hausman-Taylor model, and seemingly unrelated regressions (SUR). SUR improve the results of coefficient estimates when the data are not complete. RESULTS: The results of the SUR indicated that vehicle impoundment, community service, and alcolocks correlate with lower crashes, while detention correlates with lower fatalities. Furthermore, a higher alcohol content in beverages is positively associated with fatalities and negatively associated with the number of crashes. CONCLUSIONS: Mild and harsh measures for preventing alcohol-related crashes and fatalities differ in effectiveness; therefore, they should be used simultaneously. Blood alcohol concentration limits were found to be an ineffective tool for preventing crashes and fatalities under the influence of alcohol. PRACTICAL IMPLICATIONS: The regulatory restrictions on different types of alcohol should be stricter for hard alcohol (especially spirits) and lower for low-alcohol beverages, such as beer, if fewer fatalities are preferred to fewer crashes.

The effects of Electronic Stability Control (ESC) on fatal crash rates in the United States.

PROBLEM: Electronic Stability Control (ESC) is believed to be among the most efficient vehicle safety interventions with reported effects around 50% for fatal single and rollover crashes. However, such estimates have used sample data, which have not controlled for the possibilities of self-selection, behavioral adaptation, increased access to the technology by less safe drivers, and the calculation of effects on very specific categories of crashes. Effects of ESC in the population can therefore be expected to be smaller than is currently believed. METHOD: National U.S. data for fatal crashes, driving exposure and other control factors, and market penetration of ESC over 1991-2021 were used to calculate whether the trends in fatalities over time in crash rates for singles, rollovers, and fatal crashes in general matched projections from estimates of effectiveness. RESULTS: It was found that downward trends in the relevant crash types were generally present before ESC was introduced, and that the trends thereafter were weaker. Although some trends were consistent with effects of ESC, they were markedly smaller than the projected ones, and could be explained by other factors such as the number of vehicles per capita. At best, the effect for rollovers could be up to two-thirds of previous estimates, no effect was detected for singles, while for all fatal crashes results depended upon the type of analysis performed. These results conflict with conclusions in all published ESC crash sample studies, which have compared vehicles with and without ESC. This discrepancy can be explained by methodological errors in the previous studies using induced exposure methods and self-selected samples. PRACTICAL APPLICATIONS: Traffic safety may not be as much improved by technological interventions as believed. Alternative approaches to traffic safety are needed, which do not rely on technology that interferes with driver behavior.

Evaluation of driver drowsiness based on respiratory metrics.

BACKGROUND: The transition from alertness to drowsiness can cause considerable changes in the respiratory system, providing an opportunity to detect driver drowsiness. OBJECTIVE: The aim of this study was to determine which respiratory features indicate driver drowsiness and then use these features to classify the level of drowsiness and alertness. METHODS: Twenty male students (mean age 25.6±2.41 years) participated in the study using a driving simulator, and eight features, including expiration duration (ED), inspiration duration (ID), peak-to-peak amplitude (PA), inspiration-to-expiration time ratio (I/E ratio), driving, timing, respiration rate (RR), and yawning, were extracted from the respiratory signal generated by abdominal motions using a belt equipped with a force sensor. RESULTS: All eight features were statistically significant at the significance level of 0.05. Drowsiness can be detected using respiratory features with 88% accuracy, 82% precision, 86% recall, and an 90% F1 score. CONCLUSION: The findings of this study may be useful in the development of driver drowsiness monitoring systems based on less intrusive respiratory signal analysis, particularly for specific process automation applications when vehicle control is not in the hands of the driver.

Transport fare and road traffic crashes in Nigeria: insights from a geographical analysis.

Road traffic crashes (RTCs) are significantly high in Nigeria with serious social and health consequences. While existing studies on RTCs have mainly focused on the effect of socio-economic, environmental, human and mechanical factors to address the high rates, the relationship between road transport fares and RTCs has been glossed over in literature. Thus, this study examines the influence of road transport fares and other covariates on RTCs. Data on RTCs and the predictors between 2017 and 2022 were obtained from the records of the National Bureau of Statistics and the Federal Road Safety Corps. Spatial statistical techniques were used for the data analysis. RTCs vary across the country, and Northern Nigeria is the hot spot. Results from the spatial analysis show that road transport fares, population density, and illiteracy rate are significant predictors of RTCs. The study recommends striking a balance between fare affordability, the quality of service provided, and the implementation of effective transportation strategies.

Are crash causation studies the best way to understand system failures - Who can we blame?

The search for common and serious single causes of road crashes naturally leads to a concentration on the road user. This is supported by a legal framework in the search for the main cause and the suspect for this cause. In prevention, we havefor decades been more inclined to look for systematic improvements of all elements of the road transport system, and we direct the recommendations for actions towards system designers, organizations, products and services. In this paper the discussion about causation and prevention is broadened in the light of Vision Zero and its approach to prevention of serious and fatal injuries. We also discuss the Swedish judicial system and why the prevention approach has not been legislated or even generally accepted. Occupational health and safety legislation and road rules are compared, as well as how sustainability practices and reporting are tools to apply prevention where organizations have a natural sphere of influence that could mitigate deaths and serious injuries within value chains. It is recommended that we stop using the term causation as it is only directing actions in one direction. There is a risk that the focus on causation, in particular single causes, will deviate actions away from robust prevention countermeasures such as increased seat belt use, relevant speed limits, and well functioning roundabouts and median barriers. Furthermore, there is also a risk that important preventative actions from organizations are overlooked.

Visual function correlates of self-reported vision-related nighttime driving difficulties.

PURPOSE: To investigate the visual function correlates of self-reported vision-related night driving difficulties among drivers. METHODS: One hundred and seven drivers (age: 46.06 ± 8.24, visual acuity [VA] of 0.2logMAR or better) were included in the study. A standard vision and night driving questionnaire (VND-Q) was administered. VA and contrast sensitivity were measured under photopic and mesopic conditions. Mesopic VA was remeasured after introducing a peripheral glare source into the participants' field of view to enable computation of disability glare index. Regression analyses were used to assess the associations between VND-Q scores, and visual function measures. RESULTS: The mean VND-Q score was -3.96±1.95 logit (interval scale score: 2.46±1.28). Simple linear regression models for photopic contrast sensitivity, mesopic VA, mesopic contrast sensitivity, and disability index significantly predicted VND-Q score (P<0.05), with mesopic VA and disability glare index accounting for the greatest variation (21 %) in VND-Q scores followed by photopic contrast sensitivity (19 %), and mesopic contrast sensitivity (15 %). A multiple regression model to determine the association between the predictors (photopic contrast sensitivity, mesopic VA, mesopic contrast sensitivity, and disability index) and VND-Q score yielded significant results, F (4, 102) = 8.58, P < 0.001, adj. R2 = 0.2224. Seeing dark-colored cars was the most challenging vision task. CONCLUSION: Changes in mesopic visual acuity, photopic and mesopic contrast sensitivity, as well as disability glare index are associated with and explain night driving-related visual difficulties. It is recommended to incorporate measurement of these visual functions into assessments related to driving performance.

Desigualdades sociales urbano-rurales en la mortalidad por siniestros viales en Colombia, 1998-2019

Introducción: Anualmente se pierden 1,35 millones de vidas por causa de siniestros viales; su ocurrencia se ha relacionado, además de factores comportamentales, con desigualdades sociales. Objetivo: Analizar las desigualdades sociales urbano-rurales en la mortalidad por siniestros viales en Colombia para el periodo 1998-2019. Materiales y métodos: Estudio ecológico a partir del análisis de las tasas de mortalidad ajustadas de los grupos poblacionales urbanos y rurales estratificados por sexo. Se hicieron análisis con regresión de Joinpoint y se calcularon medidas de desigualdad simple absoluta y relativa. Resultados: Se registraron 139 323 muertes por siniestros viales, en Colombia la tasa de mortalidad por esta causa se ha venido reduciendo. En contraste con las áreas rurales, en las áreas urbanas esta reducción es más significativa. Existen desigualdades en la mortalidad entre las áreas urbanas y rurales que han venido estrechándose. No obstante, en el caso de hombres y mujeres ha venido incrementándose. Discusión: La reducción de la tasa de mortalidad por siniestros viales sugiere que las intervenciones en seguridad vial han sido efectivas. La mayor mortalidad en hombres puede explicarse a partir de factores comportamentales. Las desigualdades urbano-rurales pueden estar relacionadas con las dinámicas de desarrollo. Conclusiones: Se registra una reducción en la tasa de mortalidad por siniestros viales, la cual es más significativa en áreas urbanas. Existen desigualdades urbano-rurales en la mortalidad por esta causa. Las políticas de seguridad vial deben partir de un enfoque integrador vinculado con otras agendas políticas.

Introduction: Annually, 1,35 million lives are lost due to road accidents; their occurrence has been related, in addition to behavioral factors, to social inequalities. Objective: To analyze urban-rural social inequalities in mortality from traffic accidents in Colombia from 1998-2019. Methods and materials: Ecological study based on the analysis of standardized mortality rates adjusted for age and sex of urban and rural population groups stratified by sex. Joinpoint regression analyses were performed, and absolute and relative simple inequality measures were calculated. Results: There were 139.323 deaths from road accidents; in Colombia mortality rates from this cause has been decreasing. In urban areas, the reduction is more significant than in rural areas. Disparities in mortality between urban and rural areas have been narrowing, however, in the case of men and women, they have been increasing. Discussion: Reducing the mortality rate from road accidents suggests that road safety interventions have been effective. Behavioral factors can explain the higher mortality in men. Urban-rural inequalities can be related to development dynamics. Conclusions: There is a significant reduction in the mortality rate due to road accidents in urban areas. There are urban-rural inequalities in mortality from this cause. Road safety policies must be based on an integrative approach linked to other political agendas.

A comparative analysis of road and vehicle qualities as factors of road traffic carnage in Nigeria.

BACKGROUND AND OBJECTIVE: Carnage on roads is a growing concern in Nigeria. Over 27 persons, equivalent to more than 4 families, die daily from road traffic crashes. Two direct factors of a road crash are road quality and vehicle quality. To interrogate and compare both factors to road traffic accidents, the longitudinal study regressed secondary data on death tolls against road quality and vehicle quality. MATERIALS AND METHODS: Data on the estimated number of vehicles imported into Nigeria (1992-2021) served as the indicator of vehicle quality on Nigerian roads. The longitudinal study regressed secondary data on death tolls (2013-2019) against road quality (2006-2019) and vehicle quality (1992-2021). RESULTS: Results showed that road quality is degenerating as well as vehicle quality in Nigeria, resulting in increase in the number of road traffic crashes and the attendant death tolls. For every 1% decrease in road quality, death tolls from road traffic crashes in Nigeria increased by 0.00642% at 5% significance, and for every decrease in vehicle quality, death tolls from road traffic crashes in Nigeria increased by 0.327% at 5% significance. CONCLUSION: The study recommended increased advocacy on the sanctity of life and the need for all tiers of government to prioritize policy and implementation of improving the road quality and vehicle quality to reduce road traffic crashes and save lives on Nigerian roads.

Impact of Community Socioeconomic Characteristics on Emergency Medical Service Delays in Responding to Fatal Vehicle Crashes.

Introduction: This study aimed to determine the impact of community socioeconomic status on emergency medical services' response time for fatal vehicle crashes. Methods: Authors used the 2019 National Highway Traffic Safety Administration Fatality Analysis Reporting System and 2019-2020 Area Health Resource Files to obtain emergency medical services' time intervals and county socioeconomic characteristics (e.g., median household income, availability of trauma centers, and rurality), generating a study sample of 18,540 individuals involved in fatal vehicle crashes between January and December 2019. Generalized linear models with log-link and Gamma-family were used to obtain estimates, and other variables were adjusted in the model. Results: Both the mean time of the emergency medical service arrival to the site of the crash and the mean transport time from the crash site to hospital varied by county SES. Counties with a higher mean household income had 12% shorter emergency medical services' arrival times and up to 7% shorter emergency medical services' hospital transport times than counties with lower SES. The emergency medical services' hospital transport times by emergency medical services also varied by proximity to trauma centers and were 15% shorter in counties that had ≥2 trauma centers than in counties without trauma centers. Conclusions: This study shows socioeconomic disparities in emergency medical service rescue time for fatal vehicle crashes. Community characteristics play a major role in emergency medical services' arrival time intervals. Prior research demonstrated a strong link between the timeliness of emergency medical service response and the likelihood of survival in fatal motor vehicle accidents. These findings showing that socioeconomically disadvantaged areas and those lacking trauma facilities had slower emergency medical service rescue times, suggest that socioeconomic status may be a predictor of mortality in fatal motor vehicle accidents. Effective emergency medical services are essential to reduce the morbidity and mortality among motor vehicle crash victims; however, disparities exist in the timeliness of these services by geographic and socioeconomic county characteristics. Further research is urgently needed to inform policy interventions.

Revisiting older drivers' risks of at-fault motor vehicle collisions in Japan.

BACKGROUND: In Japan, older drivers have been encouraged to surrender their driving licenses for traffic safety despite the potential adverse social and health outcomes of driving cessation. We reconsidered such policies and social pressure by comparing the risk of at-fault motor vehicle collisions (MVCs) across the age groups of drivers. METHODS: Using the national data of police-reported MVCs that occurred between 2016 and 2020, we examined the number of at-fault MVCs per licensed driver (MVC rate) and the number of fatally and non-fatally injured persons per at-fault MVC by the sex and age groups of at-fault drivers. RESULTS: The MVC rate of older drivers was higher than that of middle-aged drivers but lower than that of young drivers. The number of injured persons among the collided counterparts (collided car occupants, motorcyclists, bicyclists, and pedestrians) per MVC caused by older drivers was not greater than that by drivers in other age groups. In fatal MVCs caused by older drivers, drivers themselves or their passengers tend to be killed rather than their collided counterparts. Overall, the results were mostly consistent between male and female drivers. CONCLUSIONS: The risk of at-fault MVCs increased with the advancing age of drivers after middle age; however, this risk among older drivers did not exceed that among young drivers, without posing a high risk of injuries to their collided counterparts.

Analysis and approach to renal trauma: A five-year experience at a level I trauma centre in north India.

PURPOSE: Renal trauma constitutes 0.5% - 5% of all trauma patients, and 10% - 20% of abdominal trauma. It is the most commonly injured organ in the genitourinary tract. Road traffic crash (RTC) is the most common cause. In recent years due to the advances in radiological imaging and endovascular techniques, there has been an increase in the nonoperative management of renal trauma. We investigated a large trauma cohort at a level I trauma centre to evaluate patients' demographics with renal trauma, their management, and the outcomes. METHODS: This was a retrospective analysis of the prospectively collected data of renal trauma patients managed from January 2016 to December 2020. Patients who visited the level I trauma centre in north India with renal trauma were included in this study. Patients who were dead on arrival in the emergency department were excluded. Demographics, mechanism of injury, presence of hemorrhagic shock, associated injuries, complications, length of hospital stay (LOS), discharge, and mortality were recorded. The data were entered in Microsoft Excel 365 and analysed using SPSS version 21. RESULTS: This study collected data from 303 renal trauma patients. Males constituted 86.5% of the patients. Most patients were young, aged from 20 - 40 years. Blunt renal trauma was the predominant mode of injury (n = 270, 89.1%). RTCs (n = 190, 62.7%) and falls from height (n = 65, 21.4%) were the 2 most common mechanisms of injury. Focused assessment with sonography in trauma was positive in 68.4% of patients. Grade III (grading by the American Association for the Surgery of Trauma) renal trauma (30.4%) was the most common grade in our study. The liver (n = 104, 34.3%) and splenic trauma (n = 96, 31.7%) were the most commonly associated injuries. Of the 303 patients, 260 (85.8%) were managed nonoperatively. The mean (SD) of the patients' LOS was 12.5 (6.5) days. There were 25 (8.3%) mortalities during the study period and all of them had associated other injuries. The comparison of LOS of isolated renal trauma group and renal trauma with associated injuries group was not statistically significant (p = 0.322). All the patients who died during the study period had renal trauma with associated other organ injuries. None of the patients with isolated renal trauma died during the study. The outcome comparison between both groups was not statistically significant (p = 0.110). CONCLUSION: Renal trauma predominantly occurs in young males, especially due to RTCs followed by fall from height. Focused assessment with sonography in trauma is not reliable in detecting renal injuries, other diagnostic tools such as contrast enhanced computed tomography torso should be considered in diagnosing and grading these injuries. Renal trauma usually does not occur in isolation. Majority are associated with other abdominal and extra abdominal injuries. Most of the times these injuries can be managed nonoperatively, which can achieve a low mortality. The patients who required surgery had high mortality as compared to patients who managed nonoperatively. These patients who required surgery had either severe renal or extra renal trauma and were in hemorrhagic shock. Renal trauma from this large cohort may contribute to improving the quality of care for patients with renal trauma by obtaining knowledge about the patient's characteristics, management, and outcomes.

Traffic safety and public health in China - Past knowledge, current status, and future directions.

Transportation-related harms have developed into a social disease, threatening public safety and health in China. We aimed to increase the global understanding of traffic safety and public health in China from past knowledge, current status, and future directions by collecting, collating, and analyzing the Chinese traffic incidents reported in the published literature. A systematic search of China National Knowledge Infrastructure, Weipu, and published articles referenced in PubMed, Web of Science and ProQuest between January 1, 1988 and April 30, 2023 was performed. China encountered the first recorded traffic accident as early as three thousand years ago in the Shang Dynasty. An increase in vehicle capacity and velocity increased the traffic risks during the transition from rickshaws and livestock to motor vehicles in varying traffic environments. Humans are not only the decisive factor of a large number of vehicles, traffic routes, and environmental variables, but also the victims at the end and starting point of traffic accidents. Injuries (mechanical force, burns) and diseases (traffic-related air pollution, noise) caused by traffic activities not only threaten public health, but also cause risks to safe driving. Analysis of traffic activities and biomarkers promotes the treatment of traffic injuries in ethology and medicine. China prepared for the construction of healthy transportation in the "decade of road safety" toward an estimation of worldwide road traffic injuries in 2030. Improvement of traffic safety concerning public health under the "Outline of the National Comprehensive Three-dimensional Transportation Network Planning" in China will propel the realization of worldwide traffic environmental advancement.

Unlocking the Narrative: Using Text Mining to Reveal the Hidden Factors behind Suicide Related Traffic Crashes.

Suicide is the deliberate act of ending a person's own life due to multifarious reasons. In the U.S., suicide is the 10th major cause of death. Nearly 45,000 people died by suicide in 2016 across the nation. It is anticipated that not all traffic crashes can be considered as accidents. Traffic crash related injuries are occasionally considered a means of suicide, and some crashes occur due to the suicidal attempts. These attempts can be made by operators of motor vehicles, jumpers into the pathway of trains, and pedestrians deliberately jumping into the vehicle trajectory. There are a handful of studies that have focused on traffic crashes (both railroad and roadway) related to suicidal incidents. This study aimed to explore the insights associated with suicide related traffic crashes (SRTCs) by collecting traffic data for seven years (2010-2016) from Louisiana. At first, exploratory data analysis was performed to examine the five Ws (who, what, why, when, and where) associated with SRTCs. Later, this study applied text network analysis, which was not performed in any of the previous studies, to provide additional contexts of these crashes. The findings of this study can shed lights on an unexplored arena of transportation safety research.

A probabilistic bias analysis on the magnitude of unmeasured confounding: The impact of driving mileage on road traffic crashes.

INTRODUCTION: Unmeasured confounding can lead to biased interpretations of empirical findings. This paper aimed to assess the magnitude of suspected unmeasured confounding due to driving mileage and simulate the statistical power required to detect a discrepancy in the effect of polypharmacy on road traffic crashes (RTCs) among older adults. METHODS: Based on Monte Carlo Simulation (MCS) approach, we estimated 1) the magnitude of confounding of driving mileage on the association of polypharmacy and RTCs and 2) the statistical power of to detect a discrepancy from no adjusted effect. A total of 1000 studies, each of 500000 observations, were simulated. RESULTS: Under the assumption of a modest adjusted exposure-outcome odds ratio of 1.35, the magnitude of confounding bias by driving mileage was estimated to be 16% higher with a statistical power of 50%. Only an adjusted odds ratio of at least 1.60 would be associated with a statistical power of about 80% CONCLUSION: This applied probabilistic bias analysis showed that not adjusting for driving mileage as a confounder can lead to an overestimation of the effect of polypharmacy on RTCs in older adults. Even considering a large sample, small to moderate adjusted exposure effects were difficult to be detected.

Spatial analysis of road traffic crashes and user based assessment of road safety: A case study of Rotterdam.

OBJECTIVE: To perform a spatial analysis of Road Traffic Crashes (RTCs) and assess road safety issues from the perspective of road users. PROBLEM STATEMENT: Although many initiatives have been taken to reduce the occurrence and severity of RTCs, they continue to persist. Existing research often investigates the spatial occurrence of RTCs or the perception of road safety issues from the road user. In doing this, only a limited number of factors that contribute to RTCs can be revealed, whereas in most RTC occurrences a multitude of factors plays a role. A more integrated approach combining both knowledge areas can contribute to improving road safety. METHODS: RTCs that occurred from 2018 to 2020 in Rotterdam, in the Netherlands, were spatially analyzed. This was performed using Network Kernel Density Estimation (NKDE) analysis. Two zones within the study area were selected to understand road users' perceptions of road safety through a survey. Furthermore, opinions toward possible recommendations for improving road safety were also collected through key informant interviews. RESULTS: NKDE resulted in a hot-spot map of the road segments in the study area that showed the frequency of RTCs using different colors. The road segments were classified based on the number of RTCs from 2018 to 2020, ranging from zero to 17.9 RTCs per kilometer. This led to the selection of a hot and cold spot zone for further analysis. The road user perception survey resulted in the discovery of qualitative responses that can be used to improve road safety in future and the possible recommendations would be well received by them. The key-informant interviews acted as a backup to the opinions given by the road users and provided insights on what is being done in the study area to improve road safety. CONCLUSION: The synthesis of findings unveiled why road users perceive some areas as dangerous and which road policies need to be revised to improve road safety in Rotterdam.

Effectiveness of first-aid education in road traffic crashes on non-healthcare professionals' knowledge, attitude, and skills: a systematic review.

This review aimed to evaluate and synthesize information on the effects of first-aid education in road traffic crashes on knowledge, attitudes, and skills among non-healthcare professionals. A qualitative study was designed according to the Prepared Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards to evaluate three outcomes, knowledge, skills, and attitude. The search strategy was performed in five databases (Science Direct, Scopus, CINAHL Plus, PubMed, and Google Scholar) to retrieve primary studies published between January 2011 and December 2021. In addition, the full texts of randomized controlled trials conducted on adults were included. Among the 2,399 articles retrieved from the databases, 2,388 were discarded, and only five studies met the inclusion criteria and were used in the final analysis and synthesis. Three of the five studies suggested that knowledge and skills are crucial in differentiating outcome factors between intervention and control groups regarding the effectiveness of first aid education. However, two studies on attitude and behaviour toward first-aid found no discernible change between the intervention and the control group. Therefore, our review revealed that only a well-structured first aid education is crucial to leverage the knowledge and skills of non-healthcare professionals before first aid provision, not attitude or behaviours.