Unsafe Practices of Motorcycle Riders in El Petén, Guatemala: A Community Observational Study and a Retrospective Institutional Review.

INTRODUCTION: Outcomes from trauma at the major referral hospital [Hospital Nacional de San Benito (HNSB)] in El Petén, Guatemala, have not been analyzed. Empirical evidence demonstrated a high number of motorcycle accidents (MAs). We hypothesized a large incidence of head trauma with poor outcomes in MAs compared to all other forms of blunt trauma. METHODS: Our hypothesis was tested by performing a community observational study and a retrospective chart review in El Petén, Guatemala. An independent observer catalogued 100 motorcycle riders on the streets of El Petén for riding practices as well as helmet utilization. HNSB does not have electronic medical records. For this study, we performed a retrospective chart review of randomly selected nonconsecutive trauma admission at HNSB between March 2018 and June 2023. Blunt trauma was compared between MAs versus all others. Variables were examined by parametric and nonparametric tests as well as contingency table analyses. RESULTS: Most motorcycles riders involved multiple individuals (2.61 ± 0.79/motorcycle). Seventy riders included children (median = 1.0 [Q1-Q3 range = 1.0-3.0]/motorcycle). Overall, only three riders were wearing helmets. Forty-one were women. Of patients presenting to HNSB with trauma, 91 charts were reviewed (33.0 [20.0-37.0] y old; male 89%), 76.7% were blunt, and 23.3% were penetrating trauma. Within blunt trauma, 57.1% were MAs versus 42.9% all others; P = 0.13. MAs were younger (29.5 [20.0-37.0] versus 34.0 [21.8-45.8] y old; P < 0.05) and of similar gender (male 82.5% versus 96.6%; P = 0.1). More MAs had a computed tomography (70.0% versus 30.0%; P < 0.01) and they were more likely to present with head trauma (72.5% versus 46.7%; P = 0.04) but similar Glasgow Coma Scale (15.0 [13.5-15.0] versus 15.0 [12.5-15.0]; P = 0.7). MAs were less likely to require surgical intervention (37.5% versus 56.7%; P = 0.05) but had similar hospital length of stay (4.0 [2-6] versus 4.0 [2-10.5] d; P = 0.5). CONCLUSIONS: Unsafe motorcycle practices in El Petén are staggering. Most trauma at HNSB is blunt, and likely from MAs. More patients with MAs presented with head trauma. However, severe trauma might be transferred to higher level hospitals or mortality might occur on scene, which will need further investigations. Assessment of mortality from trauma admissions is ongoing. These findings should lead to enforcement of safe motorcycle practices in El Petén, Guatemala.

National analysis of motorcycle associated injuries and fatalities: Wearing helmet saves lives.

INTRODUCTION: Riding a motorcycle without a helmet represents a public health risk that can result in disabling injuries or death. We aim to provide a comprehensive analysis of the impact of helmet use on motorcycle injuries, injury types, and fatalities, to highlight areas requiring future intervention. METHODS: We performed a retrospective cohort study utilizing the American College of Surgeons Trauma Quality Program Participant Use File between 2017 and 2020 analyzing motorcycle associated injuries and fatalities in adult patients with moderate and severe injury severity score in relation to helmet use. Multivariable regressions were utilized and adjusted for potential confounders. A subset analysis was performed for patients presenting with abbreviated injury scale (AIS) head ≥3 and all other body regions ≤2. RESULTS: 43,225 patients met study criteria, of which 24,389 (56.4%) were helmet users and 18,836 (43.6%) were not. Helmet use was associated with a 35% reduction in the relative risk of expiring in the hospital due to motorcycle-related injuries (aOR 0.65; 95% CI [0.59-0.70]; p < 0.001) and a decreased intensive care unit length of stay (ICU-LOS) by half a day (B = -0.50; 95% CI [-0.77, -0.24]; p < 0.001). CONCLUSION: Motorcycle riders without a helmet had significantly greater odds of increased in-hospital mortality and longer stays in the ICU than those who used a helmet. The results of this nationwide study support the need for continued research exploring the significance of helmet use and interventions aimed at improving helmet usage among motorcyclists. LEVEL OF EVIDENCE: Prognostic and epidemiological, level III.

Micromobility Vehicles, Obstructions, and Rider Safety Behaviors in New York City Bike Lanes.

Micromobility vehicles (MMVs) have become increasingly popular, particularly in urban areas where infrastructure has improved in recent years to facilitate their use. The purpose of this study was to observe protected bike lanes in 10 zones of Manhattan, NYC to: (1) describe the MMVs in bike lanes by type, phone and helmet use; and (2) document MMV users' responses to obstructions. Approximately 1 in 4 of all riders (260/998) were wearing a helmet. Fewer than 2% were observed using a phone while moving. Fewer than 9% of Citi Bike users were wearing a helmet. In contrast, over one-third of non-Citi Bike users were wearing a helmet (228 of 670, 34.03%). This difference was determined to be significant by a chi-squared test (a = 0.05) with a p-value less than 0.0001. Of the 988 MMVs observed in this study, 398 (40.28%) were motorized and 590 (59.72%) were non-motorized. A similar proportion of users of motorized riders versus non-motorized vehicles were wearing a helmet (28.14%, 112/398 versus 24.41%, 144/590). A total of 232 riders (23.50%) encountered an obstruction in their bike lane. Of these obstructions in a bike lane, 82.33% (191/232) were a car/vehicle and 17.67% (41/232) was garbage. A large majority of riders (87.93%) reacted by riding into the traffic lane. These findings suggest that further research and local education, enforcement, and legislative efforts are needed to examine and implement best practices in the safe operation of MMVs, decreasing bike lane obstructions, promoting helmet use, and raising awareness of MMV legislation.

Outcome of head injury in motorbike riders.

Objective: To determine the impact of helmet wearing on traumatic brain injury. Methods: We analyzed 400 cases of traumatic brain injury (TBI) in motorbike riders with and without helmet, from July 2017 to December 2020 presenting to the neurosurgery department at Jinnah Postgraduate Medical Center (JPMC), Karachi, Pakistan. The medical records were analyzed for CT scan findings, length of hospital stay, complications (mortality and disability), Glasgow Coma Scale (GCS) and Glasgow outcome score (GOS) at time of discharge. Result: A total of 400 patients with head injury due to motorbike accidents were included and all were male patients. They were equally divided into two groups, 200 in Group-A (with helmet) and 200 in Group-B (without helmet). Majority of the unhelmeted patients i.e. 102 (51%), needed admission in the Intensive Care Unit (ICU) compared to 70 (35%) in helmeted. When comparing non-helmeted patients to helmeted patients, the total median length of hospital stay was greater among non-helmeted patients (10 vs 05 days). Mortality was higher among non-helmeted patients seen in 50 (25%) as compared to 14 (7%) in helmeted patients. Overall, the good outcome was observed in 119 (59.5%) patients in Group-A as compared to70 (35%) patients in Group-B while 81 (40.5%) showed bad outcome in Group-A and 130 (64%) in Group-B. The failure to wear a helmet was found to be strongly linked with abnormal neuroimaging more complications, poor outcome and lower GCS on discharge as compared to patients using helmet. Conclusion: Lack of helmet use is linked to abnormal brain imaging, more complications, and a longer stay in the hospital after a head injury.

Patterns of maxillofacial trauma in helmet vs. non helmet wearing two wheeler drivers in a tertiary care center.

BACKGROUND/AIMS: The frequency and patterns of maxillofacial fractures vary by country, based on demographic, socioeconomic, cultural and environmental factors. Wearing a helmet is an efficient form of head protection for two-wheeler drivers and is now required in the vast majority of countries. The aim of this study was to compare the patterns of maxillofacial trauma in patients who wore helmets and those who did not. MATERIALS AND METHODS: The data were gathered from clinical records of patients presenting with maxillofacial trauma between January 2019 and February 2022. The inclusion criteria were met by subjects involved in two-wheeler accidents with comprehensive case records and radiological investigations. RESULTS: A total of 177 people presented following maxillofacial trauma. The mean age was 34.2 ± 12.7 years. There were 151 (85.3%) males and 26 (14.6%) females. One hundred and two patients had not been wearing a helmet, while 75 patients were wearing a helmet at the time of the accident. Mandible fractures were the most common injury in both groups, followed by zygomatic arch fractures (which were more common in non-helmet users) and dentoalveolar fractures in helmet users. CONCLUSION: There was a significant difference in the pattern and severity of maxillofacial trauma in helmet users and non-helmet users.

Road accidents in children involving light electric vehicles cause more severe injuries than other similar vehicles.

Road accidents in Israel were responsible for 23% of injuries in pediatric population between 2013 and 2017. In recent years, the massive entrance of e-bike and other light electric vehicles (called collectively LEV) into the roads is significantly changing the epidemiology of road accidents among children. The study aims to describe the causes, injury types, and other epidemiological characteristics of children injured in road accident and compare injuries of LEV to regular bicycles and other light non-electric vehicles (called collectively LNEV). This retrospective study included all referrals to pediatric emergency department due to road accidents, from April 2015 through March 2017. The details of the accidents and injuries were retrieved, and the subjects' characteristics were compared based on vehicle type. A total of 1531 children met the inclusion criteria. The study found that LEV road accidents among children cause more severe injuries than other LNEV in terms of injury severity score (ISS) (mean ISS 5.8 ± 4.9 vs. 4.7 ± 3.6, P = 0.001), head and neck injuries (18.7% vs. 12.9%, respectively, P < 0.05), lower extremities (36.5% vs. 23.9%, P = 0.001), and multisystem injuries (58.6% vs. 31.8%, P < 0.001). The findings of the current study suggest that the use of LEVs is changing the epidemiology of road accidents, which requires adjustments in accident and injury prevention strategies.Conclusion: The study results should encourage authorities to provide appropriate community-based programs to promote helmet use, introduce mandatory training and licensing program for LEV riders, and enhance enforcement. What is Known: • Road accidents are the leading cause of death among children and young adults (5 to 29 years). • In recent years, there is a massive entrance of e-bikes and other light electric vehicles on the roads. What is New: • LEV (light electric vehicle) accidents among children impose more severe injuries than other LNEVs (light non-electric vehicles) in terms of ISS, hospitalizations, and multisystem injuries. • The use of LEV is changing the epidemiology of road accidents. This change requires enhancing accident and injury prevention strategies.

Prevalence and distribution of maxillofacial trauma in tertiary care centers before/ after motorcycle helmet use law in Sullia, India-A retrospective study.

BACKGROUND/AIMS: In India, motorcycles are commonly involved in accidents and traffic rules negligence, most of which include some type of maxillofacial trauma. In September 2019, the rules for motorcycle and helmet use were modified to compulsory use in the state of Karnataka. The aim of this study was to assess the impact of mandatory helmet use on maxillofacial fractures and injuries in Sullia Taluk, Karnataka. MATERIALS AND METHODS: The study was based on the information obtained from clinical records in the K.V.G Dental College and the K.V.G Medical College from February 2019 to February 2020. The inclusion criteria were subjects who met with two-wheeler accidents with complete case records and radiological investigations. RESULTS: A total of 78 individuals reported with maxillofacial trauma from February 2019 to February 2020. The mean age was 31 ± 14 years. There were 74 (94%) males and 4 (6%) females. Forty-nine cases reported before the mandatory helmet use rule and 29 cases reported after the helmet use rule. There was a 36.3% decrease in the incidence of maxillofacial trauma, 23.5% decrease in fractures, and an 89% reduction in the number of victims who underwent open reduction and internal fixation during the post-law period. CONCLUSION: There was a significant reduction in the incidence and severity of maxillofacial trauma after the implementation of the helmet rule.

Race and Insurance Status as Predictors of Bicycle Trauma Outcome in Adults.

BACKGROUND: Race and insurance status have been shown to predict outcomes in pediatric bicycle traumas. It is unknown how these factors influence outcomes in adult bicycle traumas. This study aims to evaluate the association, if any, between race and insurance status with mortality in adults. METHODS: This retrospective cohort study used the National Trauma Data Bank Research Data Set for the years 2013-2015. Multivariate logistic regression models were used to determine the independent association between patient race and insurance status on helmet use and on outcomes after hospitalization for bicycle-related injury. These models adjusted for demographic factors and comorbid variables. When examining the association between race and insurance status with outcomes after hospitalization, injury characteristics were also included. RESULTS: A study population of 45,063 met the inclusion and exclusion criteria. Multivariate regression demonstrated that black adults and Hispanic adults were significantly less likely to be helmeted at the time of injury than white adults [adjusted odds ratio of helmet use for blacks 0.25 (95% CI 0.22-0.28) and for Hispanics 0.33 (95% CI 0.30-0.36) versus whites]. Helmet usage was also independently associated with insurance status, with Medicare-insured patients [AOR 0.51 (95% CI 0.47-0.56) versus private-insured patients], Medicaid-insured patients [AOR 0.18 (95% CI 0.17-0.20)], and uninsured patients [AOR 0.29 (95% CI 0.27-0.32)] being significantly less likely to be wearing a helmet at the time of injury compared with private-insured patients. Although patient race was not independently associated with hospital mortality among adult bicyclists, we found that uninsured patients had significantly higher odds of mortality [AOR 2.02 (AOR 1.31-3.12)] compared with private-insured patients. CONCLUSIONS: Minorities and underinsured patients are significantly less likely to be helmeted at the time of bicycle-related trauma when compared with white patients and those with private insurance. Public health efforts to improve the utilization of helmets during bicycling should target these subpopulations.

Cost-effectiveness of mandatory bicycle helmet use to prevent traumatic brain injuries and death.

BACKGROUND: Traumatic brain injury (TBI) is the main cause of mortality and severe morbidity in cyclists admitted to Dutch emergency departments (EDs). Although the use of bicycle helmets is an effective way of preventing TBI, this is uncommon in the Netherlands. An option to increase its use is through a legal enforcement. However, little is known about the cost-effectiveness of such mandatory use of helmets in the Dutch context. The current study aimed to assess the cost-effectiveness of a law that enforces helmet use to reduce TBI and TBI-related mortality. METHODS: The cost-effectiveness was estimated through decision tree modelling. In this study, wearing bicycle helmets enforced by law was compared with the current situation of infrequent voluntary helmet use. The total Dutch cycling population, consisting of 13.5 million people, was included in the model. Model data and parameters were obtained from Statistics Netherlands, the National Road Traffic Database, Dutch Injury Surveillance System, and literature. Effects included were numbers of TBI, death, and disability-adjusted life years (DALY). Costs included were healthcare costs, costs of productivity losses, and helmet costs. Sensitivity analysis was performed to assess which parameter had the largest influence on the incremental cost-effectiveness ratio (ICER). RESULTS: The intervention would lead to an estimated reduction of 2942 cases of TBI and 46 deaths. Overall, the incremental costs per 1) death averted, 2) per TBI averted, and 3) per DALY averted were estimated at 1) € 2,002,766, 2) € 31,028 and 3) € 28,465, respectively. Most favorable were the incremental costs per DALY in the 65+ age group: € 17,775. CONCLUSIONS: The overall costs per DALY averted surpassed the Dutch willingness to pay threshold value of € 20,000 for cost-effectiveness of preventive interventions. However, the cost per DALY averted for the elderly was below this threshold, indicating that in this age group largest effects can be reached. If the price of a helmet would reduce by 20%, which is non-hypothetical in a situation of large-scale purchases and use of these helmets, the introduction of this regulation would result in an intervention that is almost cost-effective in all age groups.

Effects of helmet nonuse and seating position on patterns and severity of injuries in child motorcycle passengers.

BACKGROUND: A prospective study was conducted to investigate the effects of helmet nonuse and seating position on patterns and severity of motorcycle injuries among child passengers in Taiwan. METHODS: In total, 305 child passengers aged ≤14 years who visited the emergency departments of three teaching hospitals following a motorcycle crash were recruited. Children's injury data were collected from medical records, and their riding behaviors along with operators' demographics were sourced from telephone interviews. Parental responses over the telephone about children's riding behaviors were checked by roadside observations. RESULTS: Results of the multivariable logistic regression analysis revealed that compared to child passengers aged ≥7 years, those aged ≤3 (odds ratio (OR), 2.88; 95% confidence interval (CI), 1.37~6.06) and 4~6 years (OR, 2.93; 95% CI, 1.50~5.70) were significantly more likely to have sustained a head/face injury, while those aged 4~6 years (OR, 2.76; 95% CI, 1.01~7.55) were significantly more likely to have sustained a severe injury. Compared to child passengers who were wearing a full-coverage helmet, those who were not wearing a helmet were significantly more likely to have sustained a head/face injury (OR, 3.12; 95% CI, 1.02~9.52) and a severe injury (OR, 3.02; 95% CI, 1.19~7.62). Children seated in front of the operator were significantly more likely to have experienced a head/face injury (OR, 2.22; 95% CI, 1.25~3.94) than those seated behind the operator. For each increment in the riding speed of 1 km/h, the odds of a severe injury to child passengers increased by 5% (OR, 1.05; 95% CI, 1.01~1.09). CONCLUSIONS: For the safety of child motorcycle passengers, laws on a minimum age restriction, helmet use, an adequate seating position, and riding speed need to be enacted and comprehensively enforced.

Helmet use and bicycle-related trauma injury outcomes.

Background: It is essential to identify factors that predict helmet use, so as to mitigate the injury and mortality from bicycle accidents.Objective: To examine the relationship between helmet use and the bicycle-related trauma injury outcomes among bicyclists with head/neck injury in the US.Methods: Data from the 2002-2012 National Trauma Data Bank were used, including all trauma bicycle riders involved in bicycle-related accidents whose primary reason for the hospital or Intensive Care Unit stay was head or neck injury. Using multiple logistic regression, the association between helmet use, Injury severity score (ISS), length of stay in hospital (HLOS) and Intensive Care Unit (ICULOS), and mortality was examined.Results: Of the 76,032 bicyclists with head/neck injury, 22% worn helmets. The lowest was among Blacks, Hispanics, and <17 years old. Wearing a helmet significantly reduces injury severity, HLOS, ICULOS, and mortality (i.e total and in-hospital). Males had a severe injury, longer HLOS, ICULOS, and higher mortality than female. Blacks and Hispanics had longer HLOS and ICULOS and higher total mortality than Whites, but had a similar chance for in-hospital mortality.Conclusions: More effort is needed to enhance helmet use among at-risk bicycle riders, which may reduce injury severity, HLOS, ICULOS, and mortality.

Effectiveness of a nationwide intervention to increase helmet use in Dutch skiers and snowboarders: an observational cohort study.

OBJECTIVE: Helmet use in Dutch recreational skiers and snowboarders (DRSS) remains low. This study evaluated the effects of exposure to a nationwide intervention on relevant determinants of helmet use and helmet use in DRSS. METHODS: The intervention mapping protocol was used to develop an in-season intervention programme targeted at adult DRSS. A prospective single-cohort study was conducted to evaluate the impact of intervention exposure on determinants of helmet use (ie, knowledge about head injury risk and preventive measures, risk perception, attitudes to head injury risk and helmet use and intention to helmet use) and self-reported helmet use. A random sample of 363 DRSS from an existing panel participated in this study. Data were collected using online questionnaires before and immediately after the 2010/2011 intervention season. In a separate sample of 363 DRSS, intervention reach was assessed after the 2010/2011 season. RESULTS: Overall, no significant associations were found between intervention exposure and the determinants of helmet use. However, subgroup analyses revealed intervention effects on risk perception and knowledge in specific subpopulations. Intervention exposure had a significant, positive effect on helmet use in DRSS (ß=0.23; 95% CI 0.017 to 0.44). Subgroup analyses revealed that this effect was found in: (1) skiers, (2) female DRSS, (3) young skiers and (4) intermediate skiers. Overall, intervention reach was 28.1%, with differences found between skiers and snowboarders. CONCLUSIONS: Exposure to a nationwide intervention programme was associated with increased self-reported helmet use in DRSS. Differences were found in intervention effectiveness and reach between subpopulations. These differences must be taken into account when developing and evaluating future interventions.

Perceptions regarding helmet use: a cross-sectional survey of female pillions in Karachi, Pakistan.

BACKGROUND: In 2011, road traffic injury-associated fatalities among motorized two-wheeler (MTW) pillion riders (backseat two-wheeler passengers) rose 30% in Karachi. Despite mandatory helmet laws, helmet use fell 20% the same year. This study aims to identify opinions of female pillions on helmet usage and whether various forms of media influence their self-perception. METHODS: Trained surveyors, using a survey tool used in similar studies in South Asia, conducted random, man-on-the-street interviews of 400 women in four areas of Karachi. Data pertaining to demographics, opinions on helmet laws, media influences, and helmet usage were collected. Data were analyzed in SAS 9.3 using chi-squared or Fisher's exact tests. RESULTS: Of the 400 women, 98.8% (n = 394) reported never wearing a helmet while riding on a MTW as a pillion rider. Women with a postsecondary or higher (US ninth grade) education level were more likely to be aware of helmet laws (38.6%) than women with lower education levels (24.6%, P = 0.005). Most women (82.4%, n = 329) supported mandatory laws and 97% (n = 289) recognized that disability was the more likely to result than death in event of a traumatic brain injury. Nearly all (98.5%, n = 394) stated that they would use a helmet if they were men, regardless of age, education level, or employment status. Television news was the most influential media form (83.7%, n = 334), with most women finding it effective because of its informative nature (91.3%, n = 303). CONCLUSIONS: Most Pakistani women do not personally use helmets when riding MTWs, yet most believe helmet use should be legally required for MTW riders and drivers. These data show that media outlets such as television can be used as a platform to educate the public about helmet usage, which may lead to improved helmet compliance among female MTW pillions in Pakistan. Furthermore, investigations into improved helmet comfort and appearance by collaborating with helmet manufacturers may have a positive impact on helmet use in Pakistan.

An Analysis of Technology-Related Distracted Biking Behaviors and Helmet Use Among Cyclists in New York City.

Bicycling is becoming an increasingly utilized mode of transportation in New York City. Technology-related distracted bicycling and helmet use are behaviors that can impact bike safety. The aims of this study were twofold: (1) to determine rates and types of technology-related distracted behaviors among bicyclists in the borough of Manhattan in New York City; and (2) to assess the rate of bicycle helmet use among these cyclists. Bicyclists in five popular riding areas in Manhattan were observed for a total of 50 h using a digital video camera during summer months in 2014. Videos were coded and enumerated for the total number and gender of cyclists, type of bicycle, number wearing headphones/earbuds and/or using a mobile phone, and whether the cyclist was wearing a helmet. Almost 25,000 cyclists were observed across the five selected locations (n = 24,861). Riders were almost four times more likely not to wear a helmet on rental bikes as compared with non-rentals (Citi Bike(®) OR 3.8; 95% CI 2.5, 5.9: other rental OR 3.8; 95% CI 3.0, 4.9). Significantly increased odds of not wearing a helmet were observed for females relative to males (OR 1.4; 95% CI 1.1, 1.8) across varied times and locations. Overall, rates of technology-related distraction were low, with headphone use being most prevalent. Males were more likely to wear headphones/earbuds (OR 2.0; 95% CI 1.4, 2.9), as were cyclists on Citi Bikes relative to other rental bikes (OR 2.2; 95% CI 1.3, 3.6). Findings from this study contribute to the growing literature on distracted biking and helmet use among bike share program riders and other cyclists and can inform policymakers and program planners aiming to improve bicycle safety in urban settings.

The problem of the pillion rider: India's helmet law and New Delhi's exemption.

BACKGROUND: In India, motorized two-wheeler (MTW) road traffic accidents injure or kill 72,000 women annually. Before the Motor Vehicle Act of 1988, which required mandatory helmet use for MTW riders, a study found 0.6% of all MTW pillions (backseat passengers) were helmeted. Citing religious protests to the legislation, Delhi's high court exempted the city's 12 million women from the law. We hypothesize that currently male pillions use helmets more frequently than females, and that overall pillion helmet usage has increased over the last 20 y. METHODS: Continuous video was recorded in half-hour blocks at four locations in Delhi on separate days, totaling 8 hours of high- and low-volume traffic. Videos were reviewed with at least two reviewers extracting the number of MTW pillions, as well as their gender, approximate age, and helmet usage. RESULTS: Of 4010 pillions identified, 63.8% were male, 32.4% female, and 3.3% children. Among males, there were significantly more helmeted pillions (88.4%, P < 0.001); among females, there were significantly more unhelmeted pillions (99.4%, P < 0.001). Among unhelmeted pillions, significantly more were female (81.4%) than male (P < 0.001). Current overall pillion helmet use is significantly higher than historical rate (P < 0.001). CONCLUSIONS: The significantly higher male pillion helmet usage compared with females indicates Delhi's helmet law is associated with increased compliance among those who fall under its jurisdiction. This augments the growing body of evidence that mandatory helmet laws are efficacious, thus repealing the exemption of women is an important step in increasing female pillion helmet usage.

Continuously increasing e-scooter accidents and their possible prevention in a large European city.

PURPOSE: During the last few years, the number of electric scooter (e-scooter) users has risen to an all-time high. This study aimed to analyze e-scooter related accidents and trauma prevention measures in a large European city (Vienna, Austria). METHODS: This retrospective study comprises a thorough data assessment and analysis of all e-scooter related accidents between 2018 and 2021 at a large level 1 trauma center in Vienna. Based on the data analysis, risk factors were identified, and possible prevention strategies were proposed. RESULTS: During the observed period, 1337 patients sustained an injury from an e-scooter. Of these, 1230 were injured directly while driving (92%). The remaining 107 patients (8%) were classified as non-driving injuries. 927 injuries involved males (69.3%). The mean age was 32.1 years (range 4-86 years). Of all injured patients, 429 (32.1%) sustained at least one serious injury. The most common injuries included radial head fractures and concussions. Among the accidents treated, the use of protective equipment was sporadic. For example, helmets were worn in only 13.7% of cases. Wearing a helmet reduced the number of head injuries (24% versus 46.8%). In just three years, the number of patients increased 19-fold with a focus in the summer months. CONCLUSION: This study shows a substantial and sustained increase in e-scooter accidents with potentially serious injuries. Helmet use was found to be an effective form of head injury prevention. Further options for using protective equipment should be evaluated to improve the safety aspects of riding e-scooters.

Prevalence and patterns of helmet use among motorized two-wheelers: findings from a large observational study in an Indian metropolis.

Motorized two-wheeler users account for 45% of road fatalities in 2021 in India. Correct helmet use decreases the risk of fatalities, but information about the prevalence of correct helmet use is limited in the Indian context. This study aims to assess the prevalence of helmet use and factors associated with correct helmet use among motorized two-wheeler users in Bengaluru city, India. This observational cross-sectional assessment was conducted in a random-representative sample of 98021 motorized two-wheelers sampled from 15 intersections. Helmet use and other information were collected by trained Field Data Collectors via hand-held tablet devices and the KoBo collect application, following a globally used checklist. The prevalence of helmet use (all types) was 88% among riders and pillion together and 92.4% among riders. However, the prevalence of correct helmet use is 38% among riders, and non-standard helmet use is 27%. This study reveals a correct helmet use gap in Bengaluru city. The study recommends the need to shift enforcement, messaging, and intervention focus towards correct helmet use and the implementation of routine population-based surveillance for helmet use in the city.

The Correlations Between Concussions and Chronic Traumatic Encephalopathy (CTE) in the National Football League: Why Does Society Keep Promoting Sports With High CTE Rates?

The National Football League (NFL) is a highly popular sport in the United States, attracting numerous aspiring athletes due to its lucrative pay and fame. However, the pursuit of a career in the NFL comes with significant health risks, particularly concussions and their long-term effects. Repeated head traumas in the NFL can lead to chronic traumatic encephalopathy (CTE), a neurodegenerative disease that is characterized by a spectrum ranging from cognitive and behavioral aberrations and has been linked to conditions such as Parkinson's and Alzheimer's diseases. Despite growing evidence, NFL officials have historically downplayed the connection between concussions and CTE, attributing symptoms to other factors such as performance-enhancing drugs. To address the concussion crisis, the NFL has implemented rule changes and partnered with engineers to develop safer helmets. However, the most effective approach to combating CTE involves early detection through MRI brain scans, which are a potential method for identifying the disease in living patients and subsequently facilitating early intervention. While other contact sports such as boxing have been shown to increase the risk of traumatic brain injury as well as CTE, the impact the NFL has on CTE is the most prominent in today's society. This editorial emphasizes the need for the NFL to acknowledge the clear link between concussions and CTE and to invest in comprehensive diagnostic and therapeutic strategies such as new monoclonal antibody therapies. Despite ethical and technical challenges, such as the use of embryonic stem cells and the risks associated with radioactive scans, advancing these methods could save lives and improve the long-term health outcomes of current and former NFL players. Enhanced understanding and proactive management of CTE are crucial for mitigating the severe impact of concussions in professional football.

Survey of helmet influences of female pillions in New Delhi.

BACKGROUND: In India, female motorized two-wheeler users involved in road traffic accidents account for 70,000 injuries and fatalities annually. Despite federal helmet laws, New Delhi exempted female pillion riders (backseat passengers) from mandatory helmet usage in response to religious and cultural opposition. This study attempts to elucidate factors influencing female pillion riders' helmet usage, hypothesizing religious-based opposition and poor understanding of helmet efficacy. MATERIALS AND METHODS: A cross-section of female pillion riders in five areas of New Delhi were approached by trained surveyors. Surveys were self-completed (n = 52) or completed with assistance (n = 243). Demographics, helmet use habits, opinions, and media influence data were collected. Data were analyzed using χ(2), Fisher exact test, and multivariable logistic regression. RESULTS: Of 305 women surveyed, 69.8% were Hindus (n = 213), 10.8% Muslims (n = 33), and 10.4% Sikhs (n = 32). More Muslim (33.3%, P = 0.001) and Sikh (25%, P = 0.04) women opposed mandatory helmet use compared with Hindu women (10.6%). There were 66 women who self-reported helmet use, with one woman (Sikh) who abstained from helmets for religious practices (0.9%). The most common reason for helmet disuse was discomfort (n = 40, 36.7%). Most respondents reported media positively influenced helmet use (57.7%). CONCLUSIONS: Despite arguments of infringement on religious rights, women pillions ride without helmets for comfort and appearance purposes primarily. Furthermore, though significantly fewer Sikh and Muslim women support mandatory helmet laws, supporters remain a clear majority in both groups. Most women report media outlets as influential on helmet use, principally television, suggesting that mass media campaigns may improve helmet compliance.

Computer vision-based helmet use registration for e-scooter riders - The impact of the mandatory helmet law in Copenhagen.

PROBLEM: E-scooters are a new form of mobility used more frequently in urban environments worldwide. As there is evidence of an increased risk of head injuries, helmets are recommended and (less frequently) legislated. Denmark has enacted mandatory e-scooter helmet use legislation from January 1, 2022. So far, it is unclear how this newly implemented law influenced helmet use of e-scooter riders in Denmark immediately after its implementation. METHOD: In this observational study, we register and compare e-scooter helmet use before the mandatory helmet use legislation (December 2021) and after (February 2022). As observational survey data collection in the field can be highly time-consuming, we conducted a video-based observation survey. We trained and applied a computer vision algorithm to automatically register e-scooter helmet use in the video data. RESULTS: The trained algorithm produces accurate helmet use data, which does not differ significantly from human-registered helmet use. In applying the algorithm to video data collected in December 2021 and February 2022, we register an overall e-scooter helmet use of 4.4% in n = 1054 riders. Splitting the observation between the time before and after the implementation of the helmet use law reveals a significant increase in helmet use from 1.80% to 5.56%. DISCUSSION: In this study, we successfully train and apply an object detection algorithm to register accurate helmet use data in videos collected in Copenhagen, Denmark. Using this algorithm, we find a significant impact of a new mandatory e-scooter helmet use law on e-scooter riders' helmet use behavior. Limitations of the study as well as future research needs, are discussed. PRACTICAL APPLICATIONS: Computer vision algorithms can be used for accurate e-scooter helmet assessments. Implementing a mandatory helmet use law can increase helmet use of e-scooters at specific observation sites.