[Driving competence in older age: psychological assessment and interventions]. / Fahrkompetenz im Alter: Psychologische Diagnostik und Interventionen.

The article introduces the issue of psychological assessment and training for driving safety, driving competence, and the mobility of older drivers. The psychological methods for assessing driving competence and the training approaches for maintaining mobility in old age are outlined and illustrated with examples. Preserving driving ability in old age remains a task for which development needs and research gaps must be specified. Although periodic mandatory examinations based on age do not yield any relevant improvement in enhancing traffic safety, they do not cause harm and are widely accepted. It is desirable to move away from a theory focusing on deficits of older age and instead develop an assessment of the comprehensive functions, abilities, and resources of elderly drivers to help preserve the mobility and participation of that specific demographic in traffic.

Road crossing behavior and preferences among pedestrians: From the lens of the theory of interpersonal behavior.

OBJECTIVE: As a major safety intervention, infrastructural facilities such as footbridges, underpasses or signals are provided for pedestrians to remove their direct interactions with vehicles and consequently ensure safe crossing as they attempt to cross roadways. Interestingly, it is evident that even within the proximity of footbridges or underpasses, some individuals are more willing to take the risk of crossing at-grade even where there are no signals or crosswalk markings to separate their movement from vehicles. These crossing alternatives may have different utilization depending on location and road user types. Therefore, sustainable crossing facilities are needed to meet pedestrian needs. This study attempts to investigate the factors that influence pedestrians to avoid provided footbridges and engage in at-grade crossing behaviors. METHODS: The crossing point preference is an interpersonal behavior which is a multifaceted and complex phenomenon involving conscious (intentions) and subconscious (habits) factors. This study employs Triandis' Theory of Interpersonal Behavior (TIB) as a theoretical framework and structural equation modeling to achieve study objectives. Pedestrians were intercepted randomly and socio-demographics, trip characteristics and perceptions data collected through a stated preference survey. RESULTS: Perceived consequence, affect, and social factors were found as significant antecedents of at-grade crossing intentions. Habits and facilitating conditions significantly moderate the impact of crossing intentions on actual at-grading crossing behavior. Pedestrians' perceived consequence was found to significantly mediate the impact of social factors and affective factors on intention to cross at-grade. Apart from gender, age, satisfaction with footbridge features, work trips, and crossing frequency were all significant determinants of actual crossing at-grade behavior. CONCLUSIONS: The study findings can help road safety agencies provide acceptable sustainable facilities that will be used by pedestrians to ensure that the purpose of investments toward pedestrian crossing safety is achieved. Effective road safety education and awareness campaigns on negative consequences of crossing at-grade, while highlighting the benefits of using provided footbridges are suggested to be undertaken by government agencies.

A longitudinal assessment of posttraumatic stress symptoms and pain catastrophizing after injury.

PURPOSE/OBJECTIVE: Identifying individuals with high levels of pain catastrophizing (PC) may inform early psychological interventions to prevent the transition from acute to chronic post-injury pain. We examined whether pre-and post-injury posttraumatic stress symptoms (PTSS) predict post-injury PC among emergency department (ED) patients following acute motor vehicle crash (MVC). RESEARCH METHOD/DESIGN: This study represents secondary data analysis of a randomized clinical trial (NCT03247179) examining the efficacy of the PTSD Coach app on post-injury PTSS (PTSSpost). Among 63 injured ED patients (63% female; 57% non-White; average age = 37) with moderate pain (≥4 of 10), we assessed recall of pre-injury PTSS (PTSSrecall: stemming from preexisting exposures) and baseline PC within 24 hr post-MVC; PTSSpost stemming from the MVC was assessed 30-days later, and the outcome of PC was assessed at 90-days post-injury. We controlled for group assignment (intervention vs. control) in all analyses. RESULTS: Results revealed that at baseline and 90-days, PC was higher among non-White versus White participants. After adjusting for relevant covariates, PTSSrecall uniquely predicted post-injury PC and each subscale of PC (helplessness, magnification, and rumination). Similarly, after controlling for PTSSrecall and relevant covariates, PTSSpost uniquely predicted total and subscale post-injury PC. Intervention group participants reported less rumination than control group participants. CONCLUSIONS/IMPLICATIONS: These novel findings highlight that injured Black patients may be vulnerable to post-injury PC, and that both PTSSrecall and PTSSpost significantly predict post-injury PC. Brief PTSS assessment in the ED can identify high-risk patients who may benefit from early intervention. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychological Distress, Pain and Insurance Claims Negatively Affect Long-Term Health-Related Quality of Life After Road Traffic Injuries.

OBJECTIVE: A prospective cohort study to investigate how injury and early post-injury psychosocial factors influence health outcomes 12 months after road traffic injury. METHODS: Residents of New South Wales, Australia, with road traffic injury in the period 2013-16 were recruited. Explanatory factors were evaluated for outcomes over 12 months using 12-Item Short Form Survey (SF-12) Physical and Mental Component Scores (PCS and MCS). Path models and mediation analysis were used to examine the effect of injury severity and explanatory factors. RESULTS: SF-12 PCS and MCS outcomes were poorer among participants with baseline psychological distress, for all injury severities (ß coefficients -3.3 to -9.3, p < 0.0001). Baseline pain and psychological distress, and baseline PCS and MCS were each involved in indirect effects of injury severity on 12-month PCS and MCS. Injury severity, baseline PCS and MCS, and baseline psychological distress were also associated with the likelihood of a compulsory third-party insurance claim, and claiming was negatively associated with 12-month PCS and MCS outcomes (beta coefficients -0.22 and -0.14, respectively, for both, p < 0.01). CONCLUSION: Baseline factors, including pain, psychological distress and lodging a compulsory third-party insurance claim, negatively impact long-term physical and mental health status following road traffic injury, emphasizing the importance of early screening and intervention. TRIAL REGISTRATION: Australia New Zealand Clinical trial registry identification number: AC- TRN12613000889752.

Factors influencing clinical symptoms and treatment of patients with traffic accident injuries: A retrospective chart review with a questionnaire survey.

This study analyzed factors influencing clinical symptoms and treatment of patients with traffic accident injuries. It used a retrospective chart review and questionnaire survey obtained from 560 patients (266 men and 294 women). It also conducted follow-up observations of progress after car insurance settlements and investigated the usefulness of and patient satisfaction with integrative Korean medicine treatment for traffic accident injuries. Retrospective data of patients admitted for traffic accident injury were obtained. A questionnaire survey was conducted to collect data regarding the degree of traffic accident damage, severity of pain at settlement, any treatment after settlement and duration and cost of such treatment, and patient satisfaction with car insurance services and Korean medicine treatment for traffic accident injury. The results showed no significant association between pain and the degree of damage to the car at the time of traffic accident (P = 0.662), although the degree of damage to the car was more significantly associated with time to reach a car insurance settlement than severity of pain in the patient (P = 0.003). There was no significant association between the degree of damage to the car in a traffic accident and pain after a traffic accident. Greater severity of pain at the time of the car insurance settlement was associated with greater cost and longer time spent in treatment after the car insurance settlement.

Understanding the deterrent impact formal and informal sanctions have on illegal smartphone use while driving.

The illegal use of a smartphone while driving increases the risk of crashes. As such, road authorities rely on countermeasures to reduce illegal smartphone use. Deterrence-based methods dominate road safety, however, perceptions and impact of formal (legal) and informal (non-legal) methods to deter illegal smartphone use in Australia have not yet been explored. The current study reports on a survey of 2774 drivers (47.0 % males) that own and regularly use a smartphone. The survey analysed the self-reported frequency of illegal smartphone use while driving, perceptions of formal and informal deterrence mechanisms, differences between perceived and informed deterrence, and deterrent predictors of illegal use. The findings revealed that illegal smartphone use is increasing in Victoria, Australia. Drivers that break the law perceive deterrent mechanisms significantly different from drivers that abide by the law, however, both groups view the prospect of hurting oneself as most impactful. Additionally, drivers tend to underestimate the consequences of illegal use, yet overestimate the certainty of apprehension. A binary logistic regression analysis revealed that only age, gender and informal sanctions such as social loss (stigma/peer disapproval), internal loss (shame/guilt/embarrassment), and physical loss (injury/property damage) were significant predictors of illegal use. None of the formal mechanisms were significant. Based on these findings, road safety interventions and future research should consider exploring the psychological characteristics of young people's perceptions of informal sanctions such as social loss (shame/embarrassment) and internal loss (guilt).

The effects of economic stress and urbanization on driving behaviours of Boda-boda drivers and accidents in Gulu, Northern Uganda: a qualitative view of drivers.

INTRODUCTION: Understanding motorcyclists' on-the-road behaviour is critical for developing and evaluating interventions specifically targeting them. Risky on-the-road behaviours have historically been subdivided into errors and violations of the rules of road use. Police records could be used to record cyclists' behaviours, however these documents do not necessarily capture all errors and violations. None use of protective wears have been documented in many studies conducted on Boda-boda drivers in Uganda. The relationship between drivers' economic stress and road safety have been studied for many years but the effects of global and economic stress, its joint effects on behaviours of drivers in relations to accidents have received very little attention. This study aimed at assessing the relationship between injuries and the Boda-boda drivers' behaviours in Northern Uganda. METHODS: Two hundred Boda-boda drivers from Gulu Municipality had face-to-face interviews to assess views and underlying factors on the issue of high prevalence of motorcycle road traffic accidents and injuries. Descriptive statistics were used to describe factors on road accidents including personal information, knowledge, skills and attitudes towards road use and safety. The study was approved by a local Institutional Review Board (IRB). RESULTS: Collectively, the results showed that economic stress is an important factor that affects drivers' behaviour and increases their risks to motorcycle accidents. CONCLUSION: These authors suggest that more studies should be conducted to determine the relationship between economic stress, anger and dangerous behaviours among Boda-boda drivers and accidents in Gulu Municipality using a Motorcycle Rider Behaviour Questionnaire (MRBQ).

Injury patients' perceptions of drink-driving: A qualitative assessment of drink-driving behavior in Moshi, Tanzania.

BACKGROUND: Globally, about 2.3 billion people are current alcohol drinkers, and 283 million have an alcohol use disorder. Alcohol use while driving is a major contributor to road traffic injuries (RTI). We need to understand the culture and perception of drink-driving in this setting to understand why people continue to drink drive and allow policymakers to develop more effective ways to address drink-driving behavior. This study aims to qualitatively determine what injury patients, their families, and community advisory board members in Tanzania believe about drink-driving to help inform policies to address this problem. METHODS: The semi-structured focus group was designed based on the grounded theory and assessed using thematic analysis. Focus groups participants were a convenience sample of injury patients, their families, and community advisory board (CAB) members. Analysis was iterative throughout the study. All transcripts were coded using a thematic narrative approach. Representative quotes for each theme were then selected based on comparative analysis of coding with input from research team members. RESULTS: A total of ten focus groups were conducted (4 patient, 4 family, and 2 CAB) with a total of 104 participants (37 females and 67 males). The normalization of drinking among drivers has allowed this behavior to become ingrained in the culture. Participants expressed notions that passengers are responsible for their own safety, rather than drivers being responsible for their passengers. Most participants believe it is a citizen's duty to inform the police of suspected drink-driving, however there were differing opinions about how effective informed police officers can be in practice. Focus group discussions between all three population types highlighted major themes of 'drinking is ingrained in boda boda driver culture', 'individuals have a personal responsibility to address drink-driving', and a 'police enforcement on drink-driving is necessary'. CONCLUSIONS: Normalization of drink-driving in commercial driver culture creates a dangerous environment for passengers which can be mitigated by education and health promotion. As most passengers already take personal responsibility for their own road traffic safety, they may be likely to make use of safe ride options, if available. While legislation is in place against drink-driving, police officers need to be empowered with appropriate training and funding to enforce them.

Biopsychosocial factors associated with poor health-related quality of life after minor to moderate transport-related injuries: Insights into the Victorian compensable population.

OBJECTIVE: To investigate whether a range of previously identified biopsychosocial risk factors were associated with poorer health-related quality of life after transport-related injuries. METHODS: This study involved 1,574 participants who sustained a transport-related injury, claimed compensation through the Victorian compensation scheme (in the Australian state of Victoria), and contributed to their cross-sectional outcome survey. Health-related quality of life was assessed using the EQ-5D-3L instrument. RESULTS: Of the 1,574 participants (mean age 44.8 (standard deviation 16.6) years, 61% reported poor recovery expectations, 55% reported high pain intensity, 54% reported poor satisfaction with care provided, and 41% reported no improvement in their recovery. Poor quality of life was defined as EQ-5D-3L summary score 0-0.70. Predictors of self-reported poor health-related quality of life included older age (65+ years) patients (adjusted odds ratios (aOR) = 1.73, 95% confidence interval (95% CI) 1.04-2.87), higher pain intensity (aOR = 2.17, 95% CI 1.27-3.71), self-reported pre-injury chronic pain (aOR = 1.47, 95% CI 1.00-2.17), self-reported pre-injury mental health issues (aOR = 2.62, 95% CI 1.80-3.82), no improvement in recovery in the last 3 months (aOR = 1.54, 95% CI 1.15-2.06), longer hospital stay (>7 days) (aOR = 2.34, 95% CI 1.43-4.21) and no support from the family (aOR = 2.37, 95% CI 1.62-3.46). CONCLUSION: Biopsychosocial risk factors were associated with poorer health-related quality of life, regardless of the time since injury. Early assessment of these risk factors and tailored interventions will go some way towards improving outcomes among compensable patients with minor to moderate transport-related injuries. Key words: recovery; health outcomes; road trauma; non-catastrophic injuries; compensation.

The Association Between Fault Attribution and Work Participation After Road Traffic Injury: A Registry-Based Observational Study.

Purpose To characterise associations between fault attribution and work participation and capacity after road traffic injury. Methods People aged 15-65 years, working pre-injury, without serious brain injury, who survived to 12 months after road traffic injury were included from two Victorian trauma registries (n = 2942). Fault profiles from linked compensation claims were defined as no other at fault, another at fault, denied another at fault, claimed another at fault, and unknown. Claimant reports in the denied and claimed another at fault groups contradicted police reports. Patients reported work capacity (Glasgow outcome scale-extended) and return to work (RTW) at 6, 12 and 24 months post-injury (early and sustained RTW, delayed RTW (≥ 12 months), failed RTW attempts, no RTW attempts). Analyses adjusted for demographic, clinical and injury covariates. Results The risk of not returning to work was higher if another was at fault [adjusted relative risk ratio (aRRR) = 1.67, 95% confidence interval (CI) 1.29, 2.17] or was claimed to be at fault (aRRR = 1.58, 95% CI 1.04, 2.41), and lower for those who denied that another was at fault (aRRR = 0.51, 95% CI 0.29, 0.91), compared to cases with no other at fault. Similarly, people had higher odds of work capacity limitations if another was at fault (12m: AOR = 1.49, 95% CI 1.24, 1.80; 24m: 1.63, 95% CI 1.35, 1.97) or was claimed to be at fault (12m: AOR = 1.54, 95% CI 1.16, 2.05; 24m: AOR = 1.80, 95% CI 1.34, 2.41), and lower odds if they denied another was at fault (6m: AOR = 0.67, 95% CI 0.48, 0.95), compared to cases with no other at fault. Conclusion Targeted interventions are needed to support work participation in people at risk of poor RTW post-injury. While interventions targeting fault and justice-related attributions are currently lacking, these may be beneficial for people who believe that another caused their injury.

Personality and Behavioral Predictors of Cyclist Involvement in Crash-Related Conditions.

In recent years, the increasing rate of road crashes involving cyclists with a disproportionate overrepresentation in injury statistics has become a major concern in road safety and public health. However, much remains unknown about factors contributing to cyclists' high crash rates, especially those related to personal characteristics. This study aims to explore the influence of cyclist personality traits and cycling behaviors on their road safety outcomes using a mediated model combining these constructs. A total of 628 cyclists completed an online questionnaire consisting of questions related to cycling anger, impulsiveness, normlessness, sensation seeking, risky cycling behaviors, and involvement in crash-related conditions in the past year. After the psychometric properties of the employed scales were examined, the relationships among the tested constructs were investigated using structural equation modeling. The results showed that cyclists' crash risks were directly predicted by risky cycling behaviors and cycling anger, and the effects of cycling anger, impulsiveness, as well as normlessness on crash risks, were mediated by cycling behaviors. The current findings provide insight into the importance of personality traits in impacting cycling safety and could facilitate the development of evidence-based prevention and promotion strategies targeting cyclists in China.

Bicycle Facilities Safest from Crime and Crashes: Perceptions of Residents Familiar with Higher Crime/Lower Income Neighborhoods in Boston.

While studies of bicyclist's perceptions of crime and crash safety exist, it is also important to ask lower-income predominantly-minority residents what bicycle-route surface or context they perceive as safest from crime and crashes. With their insights, their chosen bike environments could be in engineering guidelines and built in their neighborhoods to improve residents' health and lessen their risk of exposure to crime or crashing. This study involved two populations in Boston: (a) community-sense participants (eight groups-church/YMCA n = 116); and (b) street-sense participants (five groups-halfway house/homeless shelter/gang members n = 96). Participants ranked and described what they saw in 32 photographs of six types of bicycle environments. Quantitative data (Likert Scale 0⁻6 with 0 being low risk of crime/crash) involved regression analysis to test differences. Qualitative comments were categorized into 55 themes for surface or context and if high or low in association with crime or crashes. For crime, two-way cycle tracks had a significantly lower score (safest) than all others (2.35; p < 0.01) and share-use paths had a significantly higher score (least safe) (3.39; p < 0.01). For crashes, participants rated shared-use paths as safest (1.17) followed by two-way cycle tracks (1.68), one-way cycle tracks (2.95), bike lanes (4.06), sharrows (4.17), and roads (4.58), with a significant difference for any two groups (p < 0.01) except between bike lane and sharrow (p = 0.9). Street-sense participants ranked all, except shared-use paths, higher for crime and crash. For surface, wide two-way cycle tracks with freshly painted lines, stencils, and arrows were low risk for crime and a cycle track's median, red color, stencils, and arrows low risk for crash. For context, clean signs, balconies, cafes, street lights, no cuts between buildings, and flowers were low risk for crime and witnesses, little traffic, and bike signals low risk for crash. As bicycle design guidelines and general Crime Perception Through Environmental Design (CPTED) principles do not include these details, perhaps new guidelines could be written.

Comparison of US County-Level Public Health Performance Rankings With County Cluster and National Rankings: Assessment Based on Prevalence Rates of Smoking and Obesity and Motor Vehicle Crash Death Rates.

Importance: Health departments can be grouped together based on sociodemographic characteristics of the population served. Comparisons within these groups can then help with monitoring and improving the health of their populations. Objective: To compare county-level percentile rankings on outcomes of smoking, motor vehicle crash deaths, and obesity within sociodemographic peer clusters vs nationwide rankings. Design, Setting, and Participants: This cross-sectional, population-based study of demographic and health data from the 2014 Behavioral Risk Factor Surveillance System and the 2016 Robert Wood Johnson Foundation County Health Rankings data set was conducted at 3139 of 3143 US counties and county-equivalents. Four locations were excluded due to incomplete data. Data analysis was conducted between January and August 2017. Exposures: Random forest algorithms were used to identify sociodemographic characteristics most associated with the outcomes of interest. These characteristics were race and ethnicity, educational attainment, age, marital status, employment status, sex, and health insurance status. k-means clustering was used to cluster counties based on these sociodemographic characteristics and the percentage of the county classified as rural. Main Outcomes and Measures: County-level smoking prevalence, motor vehicle crash death rate, and obesity prevalence. County percentile rankings on the outcomes of interest were compared in the national context and the within-cluster context. Results: A total of 318 856 967 individuals (mean [SD] individuals per county, 101 579.2 [326 315]; 161 911 910 women [50.8%]) were represented by the 3139 counties used in this analysis. Eight distinct sociodemographic clusters throughout the United States were found. Cluster-specific percentile rankings for both smoking prevalence and motor vehicle crash death rates improved more than 70 percentile points for several counties in the rural, American Indian cluster compared with the nationwide percentiles. Conversely, the young, urban, middle to high socioeconomic status cluster included counties with cluster-specific percentile rankings that declined by 60 percentile points or more compared with the nationwide rankings for all 3 outcomes of interest. Conclusions and Relevance: Comparing county health outcomes on a nationwide or statewide basis fails to adequately account for sociodemographic context. Clustering counties by sociodemographic factors related to the outcome of interest allows a better understanding of other factors that may be shaping the prevalence of health outcomes. These groupings may also aid learning exchange.

Effects of socio-demographic, personality and mental health factors on traffic violations in Chinese bus drivers.

The present study aims to determine the association between bus drivers' socio-demographic characteristics, personality traits, mental health and traffic violations. This case-control study included 596 bus drivers who were recruited during October 2014 to May 2016, including 295 drivers with traffic violations and 301 drivers without traffic violations. The bus drivers' personality traits and mental health were assessed by the Eysenck Personality Questionnaire (EPQ) and the Symptom Checklist (SCL-90-R). Drivers aged 26-35 years were 72% less likely to be involved in traffic violations compared to drivers aged ≤25 years (OR:0.284,95%CI:0.137-0.586). Drivers with ≤2 years driving experience were associated with almost a three-fold increased risk of traffic violations compared to ≥21 years driving experience (OR:3.174,95%CI:1.097-9.187). The OR value decreased with the increase of annual income (OR:4.631,95%CI:2.667-8.042;OR:3.569,95%CI:2.038-6.251;OR:3.781,95%CI:1.999-7.151). Occasionally drinking drivers and regularly drinking drivers, compared to nondrinking drivers, exhibited a higher risk of traffic violations (OR:2.487,95%CI:1.521-4.065;OR:3.271,95%CI:1.387-7.716).Extroversion and neuroticism were identified as significant factors associated with traffic violations (OR:1.262,95%CI:1.145-1.393;OR:1.159,95%CI:1.060-1.267).Somatization increased eleven-fold risk of bus drivers' traffic violations (OR:11.185,95%CI:4.563-27.419). The results revealed that bus drivers' traffic violations were mainly affected by specific socio-demographic characteristics, personality traits and mental health, which increase the risk of traffic violations.

Are you an ambitious cyclist? Results of the cyclist profile questionnaire in Germany.

Objective: A number of studies have already grouped cyclists according to different aspects of their mobility behavior. This could be used e.g., to improve the bicycle infrastructure planning, to detect critical spots and, to reduce obstacles for cycling. This wide, preexisting, range of cyclist typologies usually concentrates on one or two influence factors and differs, content-wise, in both factors used, as well as, methodically. Based on existing cyclist typologies we extracted all possible influence factors to integrate them in one single questionnaire. The objective of this study, using an empirical, based approach, is to compare this typology of cyclists with existing ones, integrating all known influence factors of recent studies.Methods: To address these issues, we conducted a Germany-wide online survey on cycling behavior, covering all relevant aspects we derived from both literature and especially, former cyclist typology studies including: social factors; the impact of environmental, individual; and route factors; as well as motives. The main goal was to identify distinct types of cyclists, and describe them as detailed as possible. The heterogeneous sample included a total of 10,294 responses.Results: Using factor and cluster analyses, a multidimensional typology with four groups of cyclists was derived which were interpreted as: ambitious, functional, pragmatic, and passionate cyclists. In addition, socio-economic factors, cyclist's motivation, and crash history were analyzed.Conclusion: The results produced by grouping different characteristics of cyclists can lead to policy recommendations or communal bicycle traffic planning. Policy planners can estimate reactions of the different types on interventions and adjust their decisions which can serve to support already passionate cyclists or, encourage normally under-represented infrequent cyclists to cycle more. The extent of perceived safety plays here an important role in the classification, e.g., the handling of high-risk areas for crashes.

Physical, psychological and economic burden of two-wheel users after a road traffic injury: Evidence from intensive care units of three EU countries.

INTRODUCTION: This study aimed to assess the physical, psychological, and economic burden shouldered by severely injured two-wheel users in three European countries as well as the cost resulting from their hospitalization. METHODS: A total of seven public hospitals were involved in three countries: Greece, Italy, and Germany. Participants enrolled during a 12-month period starting in April 2013. Eligibility criteria included an injury sustained at Road Traffic Crashes (RTC) irrespective of the type of vehicle, hospitalization 1 day in the Intensive Care Unit (ICU) or sub-ICU, and age 18 years or over. Patients were interviewed at 1, 6, and 12 months upon admission. The study used widely recommended classifications for injury severity (Abbreviated Injury Severity [AIS]; Maximum Abbreviated Injury Severity [MAIS]) and standardized measures such as the Disability Assessment Schedule II (WHODAS 2.0), "Impact of Event Scale" (IES-R), Center for Epidemiological Studies Depression Scale (CES-D Scale). Health Care Expenditure was assessed through the Monash University Accident Research Centre (MUARC's) framework, which included measures of 'Direct' and 'Indirect' costs. Diagnosis-related groups (DRGs) were used to estimate hospitalization costs. RESULTS: A total of 54 two-wheel users enrolled in the study in all the countries and 32 completed all follow-up questionnaires. Physical disability increased over 12 months following the injury. Post Traumatic Stress Disorder (PTSD) symptoms of avoidance remained at high levels over the study period. PTSD symptoms of intrusion improved significantly during the second half of the year under investigation. The total annual cost of injury for the two-wheel users who were hospitalized in the selected ICU of all the partner countries for severe injury in 2013/2014, was estimated at €714,491 made up of €123,457 direct and €591,034 indirect costs. Men, aged 50-64 years and those who sustained slight injuries primarily at the lower extremities presented higher indirect costs per person. A total of €1032.092 was spent on hospitalization payments. Women, aged 65+ and those who sustained severe injuries at the central body region presented higher direct costs per person. Women, aged 50-64 years, those with severe injuries and a major injury at the central body and the upper body region presented the highest hospitalization costs per person. CONCLUSIONS: There is a need for effective strategies to early detect and treat groups at risk of being confronted with prolonged psychosocial and economic consequences. PRACTICAL IMPLICATIONS: A holistic understanding of the impact of injury on individuals is important in order to achieve effective treatment of psychological co-morbidities in a timely manner.

Associations of perceived neighbourhood safety from traffic and crime with overweight/obesity among South African adults of low-socioeconomic status.

BACKGROUND: The relationship between perceived neighbourhood safety from traffic and crime with overweight/obesity can provide intervention modalities for obesity, yet no relevant study has been conducted in sub-Saharan African contexts. We investigated the association between perceived neighbourhood safety from traffic and crime with overweight/obesity among urban South African adults. METHODS: This cross-sectional study included 354 adults aged ≥35 years drawn from the Prospective Urban Rural Epidemiology (PURE) cohort study. The Neighborhood Walkability Scale-Africa (NEWS-A) was used to evaluate the perceived neighbourhood safety. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to examine the associations between perceived neighborhood safety and overweight/obesity defined "normal weight" and "overweight/obese" using the 25 Kg/m2 cutoff criterion. RESULTS: In the overall sample, adults who agreed that "the speed of traffic on most nearby roads in their neighborhood was usually slow" were less likely to be overweight/obese (adjusted OR = 0.42; 95%CI 0.23-0.76). Those who agreed that "there was too much crime in their neighborhood to go outside for walks or play during the day" were more likely to be overweight/obese (OR = 2.41; 1.09-5.29). These associations were driven by significant associations in women, and no association in men, with significant statistical interactions. CONCLUSION: Perceived neighborhood safety from traffic and crime was associated with overweight/obesity among South African adults. Our findings provide preliminary evidence on the need to secure safer environments for walkability. Future work should also consider perceptions of the neighbourhood related to food choice.

Identifying the Population Sources of Alcohol Impaired Driving: An Assessment of Context Specific Drinking Risks.

OBJECTIVE: High-risk drinkers who drink in high-risk contexts like bars are recognized as a primary source of alcohol-impaired drivers and motor vehicle crashes within communities. We assess the contributions of drinking in other contexts to these outcomes. METHOD: Self-report survey data from 8,553 adults in 50 California cities were used to estimate rates of driving after drinking (DAD; driving within 4 hours of drinking any alcohol) and a measure of alcohol-impaired driving (AID; driving when having had "too much" to safely drive home) associated with drinking in bars, homes, restaurants, parties, and other contexts. RESULTS: Frequent drinking (b = .0588, z = 2.17, p = .030) and drinking outside the home, χ2(4) = 74.46, p < .001, at bars (b = .1418, z = 1.97, p = .049), and at restaurants (b = .2694, z = 5.60, p < .001) were related to greater DAD; lower risks were associated with drinking at home (b = -.0607, z = -2.16, p = .031). AID frequency was directly proportional to DAD (b = .0863, z = 8.43, p < .001) with no differences observed across contexts. Within a community of 100,000 persons over 6 months, 879 AID events were attributed to drinking at 102 restaurants and 726 AID events to drinking at 15 bars. CONCLUSIONS: Drinking at bars and restaurants contributes about equally to DAD and AID, with AID events concentrated in small populations that frequent relatively few bars and broadly distributed across large populations that frequent many restaurants. High frequencies of drinking at home were also associated with surprisingly large numbers of DAD and AID events. Observed differences between individual and community risks for DAD and AID must be addressed in place-based community prevention programs.

Red-light running behavior of cyclists in Italy: An observational study.

Accident analysis and studies on traffic revealed that cyclists' violation of red-light regulation is a typical infringement committed by cyclists. Furthermore, an association between cyclists' crash involvement and red-light violations has been found across different countries. The literature on red-light running cyclists' behavior in relation to their characteristic is still scarce. The present study, adopted an eye-observational methodology to investigates differences in cyclists' crossing behavior at intersections, with a particular attention to their demographical characteristics. The classification of cyclists' red-light behavior in risk-taking, opportunistic and law-obeying, was adopted and re-adapted to reflect more objective behaviors, eliminating any inference or judgment. Two researchers at a time observed unobtrusively at four different intersections, during morning and late afternoon peak hours, 1381 cyclists approaching the traffic light during the red phase. More than 60% of the observed cyclists violated the traffic control. Results showed that the visual search strategy displayed by the cyclists and the presence of other cyclists at the intersection are important factors in predicting the probability of red-light running behavior.