[Prevalence of use of mobile phones while driving in Italy: results of a multicentric observational study]. / La prevalenza di uso del cellulare alla guida in Italia: risultati di uno studio osservazionale multicentrico.

OBJECTIVES: to provide an overview of the use of mobile phone in Italy while driving in the years 2015-2017. DESIGN: road side observational study. SETTING AND PARTICIPANTS: a sample of 145.107 drivers in 28 cities across the national territory with a resident population of more than 10 million inhabitants (17% of the Italian population). For each city, the survey was carried out in Urban (U), Sub-Urban (SU), and Extra-Urban (EXT) areas. Data were aggregated by three geographic areas: North, Centre and South. MAIN OUTCOME MEASURES: monitoring of the use of mobile phone when driving. RESULTS: the prevalence of mobile phone use when driving is 5.6% in the North, 4.1% in the Centre, and 6.3% in the South. The stratification by urban area also shows similar values (U: 5.3%; SU: 5.1%; EXT: 7.4%). CONCLUSIONS: a considerable prevalence of use of mobile phone when driving is observable throughout Italy, with substantially homogeneous values in different territories and in areas with different levels of urbanization. This behaviour increases the risk of road traffic accidents, according to scientific literature. Despite normative sanction of this behaviour, the prevalence is still high, even though comparable to what observed in other industrialized countries. Multilevel actions could be implemented, effective according to scientific literature, not limited only to the regulatory-sanctioning ones. The reduction of the use of the mobile phone while driving can have a significant impact for public health and traffic safety, because on the prevalence data of this study it is possible to assess that potentially up to 24,000 accidents/year could be avoided in Italy.

Prevalence of use of safety devices on motorized vehicles in Italy. A multicentric road side observational study.

OBJECTIVES: to give an overview of the use of safety devices in motorized vehicles in Italy in the years 2015-2017. DESIGN: road side observational study. SETTING AND PARTICIPANTS: a sample of 232,283 road users in 28 cities across the Italian territory with a resident population of more than 10 million inhabitants (17% of the Italian population) was considered. MAIN OUTCOME MEASURES: the use of seat belts (front and rear), child restraints, and motorcycle helmets were monitored. For each city, the survey was carried out in urban, sub-urban, and extra-urban areas. Data were aggregated by three geographic areas: North, Centre, and South. Data for front seat belts was also provided for drivers and passengers separately. RESULTS: the use of front seat belts shows a dramatic geographical trend ranging from 82.6% (North) to 36.3% (South). Drivers use seat belts more frequently than passengers (63.3% vs 57.4%). The same North-South trend shows the use of rear seat belts (from 19.0% to 3.3%) and child restraints (from 59.9% to 16.6%). Helmet use was high everywhere in Italy (more than 94%). CONCLUSIONS: despite the use of safety devices, which has been mandatory for many years, compliance seems to depend on the voluntary behaviour of drivers and passengers influenced by socioeconomical and cultural patterns. The use of rear seat belts and child restraints is still far from an acceptable level, as well as the use of front seat belts in the South and in the Centre. The increased use of safety devices would have significant public health and traffic safety implications, as a potential of 327 deaths/year could be saved.

Quality of life after brain injury (QOLIBRI): Italian validation of the proxy version.

To validate the proxy version of the Quality of Life after Brain Injury (QOLIBRI) questionnaire to utilize caregivers for comparison and to evaluate the correspondence between patients' self-perceived and caregivers' perception of patients' Health-Related Quality of Life (HRQoL). Ninety-two patients with severe TBI and their main caregivers were enrolled. Patients' and caregivers' HRQoL was assessed by the Patient-QOLIBRI (Pt-QOLIBRI) and the Proxy-QOLIBRI (Pro-QOLIBRI), respectively. The Pro-QOLIBRI is a modified version of the QOLIBRI to investigate caregivers' perception of patients' HRQoL (Pro-QOLIBRIpatient-centered), and their degree of satisfaction and botheredness (Pro-QOLIBRIcaregiver centered). The patients' disability and their social reintegration was investigated by means of Glasgow Outcome Scale Extended and Community Integration Questionnaire. Pro-QOLIBRI has good internal consistency and homogeneity. There was also positive correlation between the level of satisfaction measured by Pro-QOLIBRI but not by Pt-QOLIBRI, and the disability severity and social integration of the patients. The comparison between the Pt-QOLIBRI and Pro-QOLIBRI confirmed the usefulness of the Pro-QOLIBRI, especially the caregiver-centered version, to predict the social reintegration of survivors. To our knowledge this is the first study that correlates the HRQoL of survivors, as self-perceived and as perceived by the caregivers with social reintegration.

Quality of life in persons after traumatic brain injury as self-perceived and as perceived by the caregivers.

The primary aim of the study was to adopt QOLIBRI (quality of life after brain injury) questionnaire in a proxy version (Q-Pro), i.e., to use caregivers for comparison and to evaluate whether TBI patients' judgment corresponds to that of their caregivers since the possible self-awareness deficit of the persons with TBI. A preliminary sample of 19 outpatients with TBI and their proxies was first evaluated with the Patient Competency Rating Scale to assess patients' self-awareness; then they were evaluated with the QOLIBRI Patient version (Q-Pt) and a patient-centered version of the Q-Pro. Subsequently, 55 patients and their caregivers were evaluated using the patient-centered and the caregiver-centered Q-Pro versions. Q-Pt for assessing Quality of Life (QoL) after TBI, as patients' subjective perspective and Q-Pro to assess the QoL of patients as perceived by the caregivers. The majority of patients (62.2%) showed better self-perception of QoL than their proxies; however, patients with low self-awareness were less satisfied than patients with adequate self-awareness. Low self-awareness does not impair the ability of patients with TBI to report on satisfaction with QoL as self-perceived.

Health-related quality of life after traumatic brain injury: Italian validation of the QOLIBRI.

The QOLIBRI (Quality of Life after Brain Injury) is a new international health-related quality of life (HRQoL) instrument developed for assessing the consequences of traumatic brain injury (TBI). We report the results of the Italian validation of the QOLIBRI. A total of 147 participants with TBI who had previously been discharged from the Santa Lucia Foundation rehabilitation hospital were recruited to investigate the concurrent validity of the Italian version of the QOLIBRI and to compare this instrument with several functional and cognitive-behavioral scales, taking into account various clinical parameters. The QOLIBRI met the standard criteria for internal consistency, homogeneity and test-retest reliability. The results suggest that it is very sensitive in relation to outcome as measured by the Extended Glasgow Outcome Scale (GOS-E) and other instruments for functional assessment of disability, emotions and subjective health status, including the Hospital Anxiety and Depression Scale and the Short-Form 36. The QOLIBRI avoids some of the limitations of traditional scales for quantifying residual functional capaci-Health-related quality of life after traumatic brain injury: Italian validation of the QOLIBRI, such as the Glasgow Outcome Scale and the GOS-E, and may contribute to the achievement of better quality-controlled care, medical decision-making, rehabilitation planning, and measurement of well-being and HRQoL from the patient's perspective. However, a longitudinal study is needed to assess the responsiveness of the QOLIBRI to changes over time.

Return to driving after severe traumatic brain injury: increased risk of traffic accidents and personal responsibility.

OBJECTIVE: To determine the frequency of road traffic accidents among individuals who start or resume driving after severe traumatic brain injury (TBI) and to investigate their responsibility for these accidents. DESIGN: Observational/retrospective study. PARTICIPANTS: Sixty adults with severe TBI and their caregivers. MEASURES: Return to Driving Questionnaire and Glasgow Outcome Scale. RESULTS: Thirty of the 60 participants started to drive or resumed driving after TBI. Nineteen (63%) of them were involved in traffic accidents, with personal responsibility in 26 of 36 after return to driving. Participants caused a significantly higher number of accidents after TBI than before. CONCLUSIONS: The ability to drive is frequently compromised after severe TBI. Specific rehabilitation of this complex activity should be a main goal of social reintegration programs in this population.

A preliminary investigation of road traffic accident rate after severe brain injury.

PRIMARY OBJECTIVE: to investigate the road traffic accident rate in patients who have resumed driving after severe brain injury. RESEARCH DESIGN: a retrospective study conducted by means of telephone interviews. METHODS AND PROCEDURES: The caregivers of 90 patients suffering from severe brain injury were included. All of the patients had sustained severe brain injury and prolonged coma, i.e. lasting for at least 48 hours. The caregivers were interviewed by means of a Questionnaire that investigated several aspects of driving competence after coma and the incidence of road traffic accidents. MAIN OUTCOMES AND RESULTS: All patient outcomes were evaluated by means of the Glasgow Outcome Scale (GOS). The 90 caregivers reported that 29 patients (32%) had resumed driving and that 11 of the 29 (38%) were subsequently involved in road traffic accidents. During the total duration of our patient population risk exposure, we found 11 cases in our study group, against the 4.7 expected cases calculated in the normal population. The relative risk of road traffic accidents in severe brain injury patients versus uninjured individuals was 2.3. CONCLUSIONS: Our preliminary data show that a subject who has suffered from severe brain injury and coma lasting for at least 48 hours has a statistically significant higher risk of being involved in a road traffic accident.