RESUMO
Introduction: In Dar es Salaam, Tanzania, death from road traffic crashes (RTC) occurs at roughly double the global rate. In this study, we sought to understand the locations and types of vehicles involved in RTC in Dar es Salaam encountered by a cohort of motorcycle taxi drivers previously trained in first aid. Methods: This was a quasi-non-randomized interventional study, cohort subtype, with three-month follow-up. Some 186 motorcycle taxi drivers were selected by convenience sampling from 16 heavily populated, central wards and trained in a basic hemorrhage control course. Participants reported the location and types of vehicles involved in RTCs they encountered and intervened upon through performing bleeding control interventions. Surveys were designed on KoboToolbox and administered via phone call at monthly intervals over a three-month period. The main outcome measures were the location of crash encounters and types of vehicles involved. Results: In all 62 unique participants (33.3â¯%) encountered and provided bleeding control interventions to 83 injured individuals following 69 RTC in at least 31 distinct city wards, despite training only having occurred in 16 wards. Eight crash locations were not recorded. Crashes in distant wards typically contained major roads. Most commonly, crashes involved a motorcycle without the involvement of another vehicle (n=20), followed by motorcycle vs. car/three-wheeled vehicle (n=15), motorcycle vs. bus/van (n=10), motorcycle vs. motorcycle (n=9), motorcycle vs. pedestrian (n=7), pedestrian vs. bus/van (n=2), pedestrian vs. car/three-wheeled vehicle (n=1), motorcycle vs. bicycle (n=1), multi vehicle (n=1), and other (n=3). Conclusions: Motorcycle taxi drivers trained in hemorrhage control frequently encounter and intervene upon RTC in wards where they are based as well as in distant locations, commonly in wards containing major roads. Expanding first aid training for motorcycle taxi drivers could improve timely access to emergency care for RTC victims. Since most crashes involved motorcycles, road safety training should be integrated into future courses.
RESUMO
BACKGROUND: Physical activity remains a valuable prevention for metabolic disease. The effects of Nordic walking on cardiovascular risk factors were determined in overweight individuals with normal or disturbed glucose regulation. METHODS: We included 213 individuals, aged 60 ± 5.3 years and with body mass index (BMI) of 30.2 ± 3.8 kg/m(2); of these, 128 had normal glucose tolerance (NGT), 35 had impaired glucose tolerance (IGT) and 50 had type 2 diabetes mellitus (T2DM). Participants were randomized to unaltered physical activity or to 5 h per week of Nordic walking with poles, for a 4-month period. Dietary habits were unaltered. BMI, waist circumference, blood pressure, glucose tolerance, clinical chemistry, maximal oxygen uptake (peak VO(2)) and self-reported physical activity (questionnaire) were assessed at the time of inclusion and after 4 months. The participants in the exercise-intervention group kept a walking diary. RESULTS: In the NGT exercise group, self-reported physical activity increased markedly, and body weight (-2.0 ± 3.8 kg), BMI (-0.8 ± 1.4 kg/m(2)) and waist circumference (-4.9 ± 4.4 cm) (mean ± SD) decreased. Exercise power output (12.9 ± 9.9 W) and peak VO(2) (2.7 ± 2.8 mL/kg/min) increased in the IGT exercise group. More cardiovascular risk factors were improved after exercise intervention in people with NGT compared with those with IGT or T2DM. Exercise capacity improved significantly in all three groups of participants who reported at least 80% compliance with the scheduled exercise. CONCLUSIONS: Nordic walking improved anthropometric measurements and exercise capacity. However, unsupervised Nordic walking may not provide a sufficient increase in exercise intensity to achieve ultimate health-promoting benefits on the cardiovascular parameters assessed in this study, particularly for those with disturbed glucose regulation.