Turn Around, Don't Drown: A Systematic Review of Risk Factors for Motor Vehicle-Related Drowning in Floods and its Preventive Strategies.

OBJECTIVE: Exposure to flood, one of the most widespread disasters caused by natural hazards, increases the risk of drowning. Driving through flooded waterways is a cause of death due to flood-related drowning, especially in flood-prone areas. This study aimed at identifying the risk factors for motor vehicle-related drowning in floods and its prevention strategies. METHODS: International and national databases (WOS, PubMed, Scopus, Google Scholar, Magiran, and SID) were searched in the time span from 2000 to 2022. The studies investigating the risk factors relevant to land motor vehicle-related drowning in floods and its prevention strategies were included and analyzed using thematic content analysis. RESULTS: In 14 eligible studies, risk factors for land motor vehicle-related drowning in floods were identified and categorized in 3 subthemes: driver (3 categories: socio-demographic characteristics, knowledge and attitude, and beliefs); technology (1 category: land motor vehicles); and environment (2 categories: physical and socio-economic environment). Physical and structural measures (1 category: road safety improvement) and nonstructural measures (4 categories: research and education and raising awareness, risk management, promoting social-cognitive beliefs, and reconstruction and improvement of legal infrastructure) were proposed as drowning prevention strategies. CONCLUSIONS: The knowledge, attitude, and belief of the driver; the vehicle; and the environment were the most important risk factors of driving through flooded waterways. These factors should be considered when designing programs and physical and structural strategies for future interventions to curb this dangerous and potentially fatal driving behavior.

Impacts of brightness contrast, road environment complexity, travel direction and judgement type on speed perception errors among older adult pedestrians' road-crossing decision-making.

OBJECTIVES: This study aimed to explore how various factors affect older people's vehicle speed perception to enhance their road safety as pedestrians, focusing on the impact of their cognitive and perceptual abilities on road-crossing decisions. METHODS: The study evaluated the effects of brightness contrast (high, medium and low), road complexity (high and low) and vehicle travel direction (same and opposite) on speed perception errors in simulated traffic settings. It involved 38 older participants who estimated the speed of a comparison vehicle under two judgement conditions. RESULTS: Findings showed a consistent underestimation of speed in all conditions. A repeated-measure ANOVA revealed that speed perception errors were significantly higher with low brightness contrast, in simpler road environments, with vehicles travelling in the same direction, and when using absolute judgements. CONCLUSIONS: These results have practical importance for public safety initiatives, traffic regulation and road design catering to older adults' perceptual needs. They also provide valuable insights for driver training programs for older adults, aimed at enhancing their understanding and management of perceptual biases.

Identifying the key characteristics, trends, and seasonality of pedestrian traffic injury at a major trauma center in Saudi Arabia: a registry-based retrospective cohort study, 2017-2022.

BACKGROUND: Pedestrian traffic injuries are a rising public health concern worldwide. In rapidly urbanizing countries like Saudi Arabia, these injuries account for a considerable proportion of trauma cases and represent a challenge for healthcare systems. The study aims to analyze the key characteristics, seasonality, and outcomes of pedestrian traffic injuries in Riyadh, Saudi Arabia. METHODS: This study was a retrospective cohort analysis of all pedestrian traffic injuries presented to King Saud Medical City, Riyadh, and included in the Saudi Trauma Registry (STAR) database between August 1, 2017, and December 31, 2022. The analysis of metric and nominal variables was reported as mean (standard deviation, SD) or median (interquartile range, IQR) and frequencies (%), respectively. A logistic regression analysis was performed to examine the influence of patients' pre-hospital vitals and key characteristics on arrival at the ED on the need for mechanical ventilation and in-hospital mortality. RESULTS: During the study period, 1062 pedestrian-injured patients were included in the analysis, mostly males (89.45%) with a mean (SD) age of 33.44 (17.92) years. One-third (35.88%) of the patients were Saudi nationals. Two-thirds (67.04%) of the injuries occurred from 6 p.m. until 6 a.m. Compared to other years, a smaller % of injury events (13.28%) were noticed during the COVID-19 pandemic (2020). Half (50.19%) of the patients were transported to the emergency department by the Red Crescent ambulance, and 19.68% required intubation and mechanical ventilation. Most of the patients (87.85%) were discharged home after completion of treatment, and our cohort had a 4.89% overall mortality. The logistic regression analysis showed the influence of patients' pre-hospital vitals and key characteristics on arrival at the ED on the need for mechanical ventilation (Chi2 = 161.95, p < 0.001) and in-hospital mortality (Chi2 = 63.78, p < 0.001) as a whole significant. CONCLUSION: This study details the demographic, temporal, and clinical trends of pedestrian traffic injuries at a major Saudi trauma center. Identifying high-risk individuals and injury timing is crucial for resource allocation, targeting road safety interventions like public awareness campaigns and regulatory reforms, and improving prehospital care and patient outcomes.

Comparison of Traumatic Spinal Fracture Patterns Between Motorcyclists and Occupants of Other Nonheavy Motor Vehicles: A Report from the National Spinal Cord and Column Injury Registry of Iran.

OBJECTIVE: To compare traumatic spinal injury patterns between motorcyclists and occupants of other nonheavy motor vehicles using data from the National Spinal Cord and Column Injury Registry of Iran. METHODS: All drivers/riders and passengers of motorcycles, cars, pick-up trucks, and vans registered between January 2017 to July 2023, met the inclusion criteria for the present study. The logistic regression models were used to compare the patterns of vertebral fracture between the 2 groups. RESULTS: One thousand seven hundred twenty-six spinal fracture patients were identified, 385 (22.3%) motorcyclists and 1341 (77.7%) car occupants with mean ages 33.2 ± 14.3 and 36.1 ± 13.6 years, respectively (P < 0.001). Only 45 (11.7%) motorcyclists used helmets, whereas 856 (63.8%) car occupants used seat belts (P < 0.001). The average numbers of fractured vertebrae were 3.9 ± 1.4 and 3.7 ± 1.1 among car occupants and motorcyclists, respectively (P = 0.004). The proportions of motorcyclists and car occupants with injuries in each spinal region are as follows: lumbar (50.5% of motorcyclists vs. 40.4% of car occupants; P = 0.003), thoracic (39.2% vs. 30.9%; P = 0.01), cervical (24.3% vs. 37.0%; P < 0.001), and sacral (1.3% vs. 7.5%; P < 0.001). The AO Spine type C injuries were present in 6.1% of motorcyclists and 10.1% of car occupants (P = 0.03). CONCLUSIONS: Motorcyclists were younger, less educated, had a higher proportion of males, and less commonly used safety devices than car occupants. The most commonly fractured spine region among both groups was the lumbar region. The cervical and sacral vertebrae fractures were significantly more common in car occupants, whereas the thoracic and lumbar vertebrae fractures were significantly more common in motorcyclists.

Effect of eco-driving on commercial motor vehicle driver collision risk.

INTRODUCTION: This study investigates the effect among commercial motor vehicle (CMV) drivers of the adoption of fuel-efficient driving techniques (commonly known as eco-driving) on the odds of being involved in safety-related events. METHOD: For 2,637 long-haul class 8 drivers employed by four carriers in Canada, information on driving style, total distance driven, and safety-related events like collisions, hard-braking, hard-turning, and stability control events were collected for each trip. Three carriers provided driving style-related data from the ISAAC instrument, which provides a score on a 0 to 100 scale that measures the degree to which a driver is using an appropriate amount of engine power according to driving conditions. The fourth carrier provided data on driving style characteristics, including fuel consumption, use of cruise control, and use of top gear. Depending on the carrier, information on speeding, driver age, and years of experience driving a commercial vehicle was also collected. Logit statistical models were developed to estimate the change in odds of a driver experiencing a safety-related event dependent on the measures of driving style. RESULTS: A one-unit increase in the ISAAC score was associated with a 7%, 8%, 8%, and 4% reduction in the odds of having a hard-braking event, hard left-turn event, hard right-turn event, and collision, respectively. For the carrier not employing the ISAAC system, an increase of 10% in the time spent driving in top gear with steady speed near 100 km per hour (km/h) was associated with a substantial 34% decrease in stability control events. In addition, a year increase in the driver's age, as well as a 1% increase in the amount of time spent driving using cruise control, reduced the number of hard-braking events by 9% and 3%, respectively. Conclusion/Practical Applications: The adoption of fuel-efficient driving techniques enhances the safety of CMV drivers.

Influencing factors of microplastic generation and microplastic contamination in urban freshwater.

This research analyzes data on the microplastic (MP) contamination in the environmental systems (atmosphere, lithosphere, hydrosphere) and the levels of MPs in freshwater of cities with different levels of national income. This study investigates the influencing factors of MP generation, i.e., mismanaged plastic waste, untreated wastewater, number of registered motor vehicles, and stormwater runoff. The statistical correlations between the MP contamination in urban freshwater and the four influencing factors of MP generation are determined by linear regression. The results indicate that MPs are most abundant in aquatic systems (i.e., hydrosphere) and pose a serious threat to the human food chain. The regression analysis shows a strong correlation between mismanaged plastic waste and microfragment smaller than 300 µm in particle size in urban freshwater with high goodness-of-fit (R2 = 0.8091). A strong relationship with high goodness-of-fit also exists between untreated wastewater and microfragment of 1000-5000 µm in particle size (R2 = 0.9522). The key to mitigate the MP contamination in urban freshwater is to replace improper plastic waste management and wastewater treatment with proper management practices.

Seat belt use and cardiac arrest immediately after motor vehicle collision: Nationwide observational study.

Objective: Motor vehicle collisions (MVCs) are known to cause traumatic cardiac arrest; it is unclear whether seat belts prevent this. This study aimed to evaluate the association between seat belt use and immediate cardiac arrest in cases of MVCs. Method: This cross-sectional observational study used data from a nationwide EMS-based severe trauma registry in South Korea. The sample comprised adult patients with EMS-assessed severe trauma due to MVCs between 2018 and 2019. The primary, secondary, and tertiary outcomes were immediate cardiac arrest, in-hospital mortality, and death or severe disability, respectively. We calculated the adjusted odds ratios (AORs) of immediate cardiac arrest with seat belt use after adjusting for potential confounders. Results: Among the 8178 eligible patients, 6314 (77.2 %) and 1864 (29.5 %) were wearing and not wearing seat belts, respectively. Immediate cardiac arrest, mortality, and death/severe disability rates were higher in the "no seat belt use" group than in the "seat belt use" group (9.4 % vs. 4.0 %, 12.4 % vs. 6.2 %, 17.7 % vs. 9.9 %, respectively; p < 0.001). The former group was more likely to experience immediate cardiac arrest (AOR [95 %CI]: 3.29 [2.65-4.08]), in-hospital mortality (AOR [95 %CI]: 2.72 [2.26-3.27]), and death or severe disability (AOR [95 %CI]: 2.40 [2.05-2.80]). Conclusion: There was an association between wearing seat belts during MVCs and a reduced risk of immediate cardiac arrest.

Database of emission factors of volatile organic compound (VOC) species in motor vehicle exhaust in China.

The synergistic strategy for fine particulate matter (PM2.5) and O3 pollution prevention and control has emerged as a pivotal approach in combating air pollution. Volatile organic compounds (VOCs) serve as crucial precursors to both O3 and secondary organic aerosols (SOAs), with motor vehicles representing one of their significant sources. In this study, a standard for establishing a database of VOC species emission factors for motor vehicles was developed, and a database containing 134 VOC species was constructed through field tests and literature surveys. The VOC emissions of light-duty gasoline passenger vehicles (LDGPVs) comprised primarily alkanes and aromatics. The VOC emissions of light-duty diesel trucks (LDDTs) comprised mostly alkanes. Regarding low-speed trucks, 3-wheel vehicles, medium-duty diesel trucks (MDDTs) and heavy-duty diesel trucks (HDDTs), their VOC emissions comprised mainly oxygenated volatile organic compounds (OVOCs). The update of emission standards resulted in a reduction in VOC species emission factors while altering the composition of VOCs. Attention should be directed toward isopentane, benzene and dichloromethane emitted by LDGPVs, dodecane, undecane, ethene and propene emitted by LDDTs, and acetaldehyde emitted by HDDTs. VOC species originating from LDGPVs were more dispersed than those originating from LDDTs and HDDTs. In addition, variations in VOC species were observed among motor vehicles with different fuel types. Toluene, ethene, benzene, m,p-xylene, isopentane, hexanal, ethyne and 1,2,4-trimethylbenzene were the predominant VOC species emitted by gasoline vehicles. Diesel vehicles emitted mainly dodecane, formaldehyde, propene, undecane, acetaldehyde, ethene, decane and benzene. The results could enhance our comprehension of the emission characteristics of VOC species originating from motor vehicles and provide data support and a scientific foundation for achieving synergistic PM2.5 and O3 pollution prevention and control.

Factors Associated with the Number of Injured and Fatalities in Motor Vehicle Intentional Mass-Casualty Incidents: A Timely Aid for Scaling the Emergency Response.

INTRODUCTION: Intentional mass-casualty incidents (IMCIs) involving motor vehicles (MVs) as weapons represent a growing trend in Western countries. This method has resulted in the highest casualty rates per incident within the field of IMCIs. Consequently, there is an urgent requirement for a timely and accurate casualty estimation in MV-induced IMCIs to scale and adjust the necessary health care resources. STUDY OBJECTIVE: The objective of this study is to identify the factors associated with the number of casualties during the initial phase of MV-IMCIs. METHODS: This is a retrospective, observational, analytical study on MV-IMCIs world-wide, from 2000-2021. Data were obtained from three different sources: Targeted Automobile Ramming Mass-Casualty Attacks (TARMAC) Attack Database, Global Terrorism Database (GTD), and the vehicle-ramming attack page from the Wikipedia website. Jacobs' formula was used to estimate the population density in the vehicle's route. The primary outcome variables were the total number of casualties (injured and fatalities). Associations between variables were analyzed using Spearman's correlation coefficient and simple linear regression. RESULTS: Forty-six MV-IMCIs resulted in 1,636 casualties (1,430 injured and 206 fatalities), most of them caused by cars. The most frequent driving pattern was accelerating whilst approaching the target, with an average speed range between four to 130km/h and a distance traveled between ten to 2,260 meters. The people estimated in the MV-IMCI scenes ranged from 36-245,717. A significant positive association was found of the number affected with the estimated crowd in the scene (R2: 0.64; 95% CI, 0.61-0.67; P <.001) and the average vehicle speed (R2: 0.42; 95% CI, 0.40-0.44; P = .004). CONCLUSION: The estimated number of people in the affected area and vehicle's average speed are the most significant variables associated with the number of casualties in MV-IMCIs, helping to enable a timely estimation of the casualties.

Improved Spatial Resolution in Modeling of Nitrogen Oxide Concentrations in the Los Angeles Basin.

The extent to which emission control technologies and policies have reduced anthropogenic NOx emissions from motor vehicles is large but uncertain. We evaluate a fuel-based emission inventory for southern California during the June 2021 period, coinciding with the Re-Evaluating the Chemistry of Air Pollutants in CAlifornia (RECAP-CA) field campaign. A modified version of the Fuel-based Inventory of Vehicle Emissions (FIVE) is presented, incorporating 1.3 km resolution gridding and a new light-/medium-duty diesel vehicle category. NOx concentrations and weekday-weekend differences were predicted using the WRF-Chem model and evaluated using satellite and aircraft observations. Model performance was similar on weekdays and weekends, indicating appropriate day-of-week scaling of NOx emissions and a reasonable distribution of emissions by sector. Large observed weekend decreases in NOx are mainly due to changes in on-road vehicle emissions. The inventory presented in this study suggests that on-road vehicles were responsible for 55-72% of the NOx emissions in the South Coast Air Basin, compared to the corresponding fraction (43%) in the planning inventory from the South Coast Air Quality Management District. This fuel-based inventory suggests on-road NOx emissions that are 1.5 ± 0.4, 2.8 ± 0.6, and 1.3 ± 0.7 times the reference EMFAC model estimates for on-road gasoline, light- and medium-duty diesel, and heavy-duty diesel, respectively.

Variation in drivers' seat belt use by indicators of community-level vulnerability.

INTRODUCTION: Examining crash reports with linked community-level indicators may optimize efforts aimed at improving traffic safety behaviors, like seat belt use. To examine this, quasi-induced exposure (QIE) methods and linked data were used to (a) estimate trip-level seat belt non-use of New Jersey (NJ) drivers and (b) determine the degree to which seat belt non-use is associated with community-level indicators of vulnerability. METHOD: Driver-specific characteristics were identified from crash reports (age, sex, number of passengers, vehicle type) and licensing data (license status at the time of the crash). Geocoded residential addresses were leveraged within the NJ Safety and Health Outcomes warehouse to create quintiles of community-level vulnerability. QIE methods were applied to estimate trip-level prevalence of seat belt non-use in non-responsible, crash-involved drivers between 2010-2017 (n = 986,837). Generalized linear mixed models were then conducted to calculate adjusted prevalence ratios and 95 % confidence intervals for being unbelted for driver-specific variables and community-level indicators of vulnerability. RESULTS: Drivers were unbelted during 1.2 % of trips. Males, those with suspended licenses, and those without passengers had higher rates of being unbelted than their counterparts. An increase was observed in traveling unbelted with increasing quintiles of vulnerability, such that drivers in the most vulnerable communities were 121 % more likely to be unbelted than those in the least vulnerable communities. CONCLUSIONS: Prevalence of driver seat belt non-use may be lower than previously estimated. Additionally, communities with the highest amount of the population living with three or more indicators of vulnerability have higher rates of seat belt non-use; this may be a particularly useful metric to inform future translational efforts improving seat belt use. PRACTICAL APPLICATIONS: As evidenced by the findings that risk of being unbelted increased as drivers' community vulnerability increased, novel communication efforts tailored to drivers from vulnerable neighborhoods may optimize efforts.

Pedestrian Safety Among High School Runners: A Case Series.

BACKGROUND: Participation in high school cross-country and track has increased over the last few decades. At the same time, the rate of pedestrian-involved motor vehicle crashes (MVCs) has also increased. In the context of organized sport, pedestrian safety among runners is often not highlighted, despite the risk of catastrophic injury. PURPOSE: To describe incidents of pedestrian-involved MVCs involving student athletes captured by the National Center for Catastrophic Sport Injury Research (NCCSIR) at the University of North Carolina at Chapel Hill. STUDY DESIGN: Case series. LEVEL OF EVIDENCE: Level 5. METHODS: This study utilized surveillance data from the NCCSIR from 2011 to 2020. It presents descriptive statistics, including frequencies and percentages, detailed summaries, and a Haddon Matrix. RESULTS: There were 8 incidents involving 11 student athletes, resulting in 9 fatalities. Of these, 5 cases occurred in the afternoon or early evening, 4 occurred in the Fall, and 6 occurred in a rural area. Haddon Matrix analyses of case descriptions indicate schools should implement a runner safety program for all new runners and ensure that runner safety measures are included in emergency action plans. CONCLUSION: Runner-related MVCs are relatively rare, but tragic, incidents. Pedestrian safety measures should be incorporated into school-sponsored practices and training runs. CLINICAL RELEVANCE: Pedestrian safety should be incorporated into runner safety and injury prevention efforts.

Risk of permanent medical impairment after road traffic crashes: A systematic review.

PURPOSE: To systematically review the risk of permanent disability related to road traffic injuries (RTIs) and to determine the implications for future research regarding permanent impairment following road traffic crashes. METHODS: We conducted this systematic review according to the preferred reporting items for systematic reviews and meta-analysis statement. An extended search of the literature was carried out in 4 major electronic databases for scientific research papers published from January 1980 to February 2020. Two teams include 2 reviewers each, screened independently the titles/abstracts, and after that, reviewed the full text of the included studies. The quality of the studies was assessed using the strengthening the reporting of observational studies in epidemiology (STROBE) checklist. A third reviewer was assessed any discrepancy and all data of included studies were extracted. Finally, the data were systematically analyzed, and the related data were interpreted. RESULTS: Five out of 16 studies were evaluated as high-quality according to the STROBE checklist. Fifteen studies ranked the initial injuries according to the abbreviated injury scale 2005. Five studies reported the total risk of permanent medical impairment following RTIs which varied from 2% to 23% for car occupants and 2.8% to 46% for cyclists. Seven studies reported the risk of permanent medical impairment of the different body regions. Eleven studies stated the most common body region to develop permanent impairment, of which 6 studies demonstrated that injuries of the cervical spine and neck were at the highest risk of becoming permanent injured. CONCLUSION: The finding of this review revealed the necessity of providing a globally validated method to evaluate permanent medical impairment following RTIs across the world. This would facilitate decision-making about traffic injuries and efficient management to reduce the financial and psychological burdens for individuals and communities.

Risk of permanent medical impairment after road traffic crashes: A systematic review / 中华创伤杂志(英文版)

PURPOSE@#To systematically review the risk of permanent disability related to road traffic injuries (RTIs) and to determine the implications for future research regarding permanent impairment following road traffic crashes.@*METHODS@#We conducted this systematic review according to the preferred reporting items for systematic reviews and meta-analysis statement. An extended search of the literature was carried out in 4 major electronic databases for scientific research papers published from January 1980 to February 2020. Two teams include 2 reviewers each, screened independently the titles/abstracts, and after that, reviewed the full text of the included studies. The quality of the studies was assessed using the strengthening the reporting of observational studies in epidemiology (STROBE) checklist. A third reviewer was assessed any discrepancy and all data of included studies were extracted. Finally, the data were systematically analyzed, and the related data were interpreted.@*RESULTS@#Five out of 16 studies were evaluated as high-quality according to the STROBE checklist. Fifteen studies ranked the initial injuries according to the abbreviated injury scale 2005. Five studies reported the total risk of permanent medical impairment following RTIs which varied from 2% to 23% for car occupants and 2.8% to 46% for cyclists. Seven studies reported the risk of permanent medical impairment of the different body regions. Eleven studies stated the most common body region to develop permanent impairment, of which 6 studies demonstrated that injuries of the cervical spine and neck were at the highest risk of becoming permanent injured.@*CONCLUSION@#The finding of this review revealed the necessity of providing a globally validated method to evaluate permanent medical impairment following RTIs across the world. This would facilitate decision-making about traffic injuries and efficient management to reduce the financial and psychological burdens for individuals and communities.

Distance From Home to Motor Vehicle Crash Location: Implications for License Restrictions Among Medically-At-Risk Older Drivers.

In 30 states, licensing agencies can restrict the distance from home that "medically-at-risk" drivers are permitted to drive. However, where older drivers crash relative to their home or how distance to crash varies by medical condition is unknown. Using geocoded crash locations and residential addresses linked to Medicare claims, we describe how the relationship between distance from home to crash varies by driver characteristics. We find that a majority of crashes occur within a few miles from home with little variation across driver demographics or medical conditions. Thus, distance restrictions may not reduce crash rates among older adults, and the tradeoff between safety and mobility warrants consideration.

Facial injury burden of personal mobility devices: a single-center retrospective analysis.

BACKGROUND: Personal mobility devices (PMDs) have become an increasingly popular transport modality globally. With increasing social interest in and demand for PMDs, the number of individuals visiting emergency departments with PMD-related injuries has also increased annually. This study aimed to evaluate injury patterns and treatment costs for patients treated in the department of plastic surgery in a trauma center. METHODS: In this retrospective study, data concerning patients with PMD-related injuries from January 2017 to December 2021 were reviewed. The data retrieved included age, sex, alcohol consumption, helmet use, the type of impact, onset of injury, place of first visit, type of injury, admission status, operation status, and treatment cost. Multiple linear regression analysis was performed to determine the effects of various factors on cost. RESULTS: Data were collected from 93 patients. Until 2019, the annual number of PMD-related accidents was less than 10; however, this number increased sharply in 2020. The average cost of hospitalization was USD 7,698 whereas the average cost of non-hospitalization was USD 631. Only fractures had a significant association with total cost in linear regression analysis (p < 0.001). CONCLUSION: The prevalence of PMD use and related injuries requiring plastic surgery during the study period showed significant health and financial costs both to the patients involved and to society. This cost could be reduced through stricter regulations concerning PMD use, advocating the use of protective gear, and promoting greater awareness of safety measures and of the consequences of PMD-related accidents.

Type 2 diabetes mellitus increases the severity of non-fatal injuries, but not the risk of fatal injuries, among driver victims of motor vehicle crashes in Taiwan.

OBJECTIVES: Limited information is available on whether diabetes increases the severity of injuries from motor vehicle crashes (MVCs). This study aimed to investigate the association of type 2 diabetes with injury severity among driver victims of MVCs. METHODS: This cohort study involved 75,737 adult driver victims with type 2 diabetes from Taiwan's Police-Reported Traffic Accident Registry in 2015-2017, along with 150,911 sex-, age-, and calendar year-matched controls. The severity level of non- fatal injuries was derived from the International Classification of Diseases Programs for Injury Categorization based on the diagnostic codes of National Health Insurance claims within 3 days after an MVC. Information on fatal injuries within 3 days after an MVC was obtained from the Taiwan Death Registry. Logistic regression models were used to estimate the odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) of injury severity in association with type 2 diabetes. RESULTS: After adjusting for potential confounders, driver victims with type 2 diabetes experienced significantly higher risks of mild and severe non-fatal injuries than their counterparts without diabetes, with covariate-adjusted ORs of 1.08 (95% CI, 1.05 to 1.11) and 1.28 (95% CI, 1.20 to 1.37), respectively. By contrast, the adjusted OR for fatal injuries was not significantly elevated, at 1.02 (95% CI, 0.89 to 1.18). Similar results were found when car and scooter driver victims were analyzed separately. CONCLUSIONS: Type 2 diabetes was found to moderately increase the severity of non-fatal injuries from MVCs among car and scooter driver victims.

Improving the safety relevance of automatic emergency braking testing programs: An examination of common characteristics of police-reported rear-end crashes in the United States.

OBJECTIVE: Forward collision warning and automatic emergency braking (AEB) systems help prevent rear-end crashes where a vehicle strikes the rear of another. However, the benefits may be limited if the systems are stymied by common crash circumstances or only target scenarios evaluated in vehicle testing programs. This study examined the prevalence of characteristics that may limit AEB system performance in police-reported rear-end crashes and the relevance of scenarios used to evaluate these systems. METHODS: Police-reported rear-end crashes (n = 6,731,215, Crash Report Sampling System) and fatal rear-end crashes (n = 4,285, Fatality Analysis Reporting System) with a fatality in the striking or struck vehicle during 2016-2019 were analyzed. Percentages of police-reported rear-end crashes, nonfatal-injury rear-end crashes, and fatal rear-end crashes were computed to identify common crash characteristics. Roadway speed limit was used as a proxy for striking vehicle speed. RESULTS: A straight-moving vehicle striking a stopped or decelerating vehicle on roads with a speed limit of 40 km/h (25 mph) or less only accounted for 3% of all rear-end crashes, 3% of nonfatal-injury rear-end crashes, and 1% of fatal rear-end crashes. In contrast, 36% of all rear-end crashes, 36% of nonfatal-injury rear-end crashes, and 11% of fatal rear-end crashes involved a straight-moving vehicle striking a stopped or decelerating vehicle on roads with a speed limit between 56 and 72 km/h (35 and 45 mph). A medium or heavy truck was the struck vehicle in 32% of fatal rear-end crashes, and a motorcycle was the struck vehicle in 11% of fatal rear-end crashes. At least one of the following characteristics that may degrade AEB system performance was present in 14% of the rear-end crashes studied: striking vehicle turning; a struck vehicle turning or changing lanes; a struck vehicle that is not a passenger vehicle; wintery weather; wet or icy roads; or a speed limit of 113 km/h (70 mph) or higher. CONCLUSION: Circumstances shown to diminish AEB effectiveness accounted for 14% of rear-end crashes, and scenarios currently used to evaluate AEB systems accounted for 3%. Evaluating AEB systems at speeds up to 72 km/h (45 mph) and incorporating a motorcycle or medium/heavy truck target will make AEB evaluations more representative of police-reported rear-end crashes.

Driving, Social Distancing, Protective, and Coping Behaviors of Older Adults Before and During COVID-19.

A thorough understanding of individual characteristics of older adults during the COVID-19 pandemic is critical for managing the ongoing pandemic course and planning for the future pandemics. Here, we explore the impact of the COVID-19 pandemic on driving, social distancing, protective, and coping behaviors of older adults. This study reports data on participants aged above 65 whose driving behaviors are being monitored using Global Positioning System (GPS) devices. Participants completed a COVID-19 survey in May 2020. We found that older adults decreased their number of days driving, number of trips per day, as well as average driving speed, and had fewer speeding incidents following COVID-19 onset. We also show that female and African American older adults engaged in more positive coping and cleaning behaviors, and had greater decreases in the number of days driving during the pandemic. The findings highlight the importance of considering older adults' individual characteristics for an equitable response to the COVID-19 pandemic.

Risk factors of road traffic accidents in Rural and Urban areas of indonesia based on the national survey of year 2018.

Context: Indonesia has a large population with a large number of motorised vehicles, so it cannot be separated from traffic accidents. Aims: This study aimed to determine and analyse the advanced level risk factors for road traffic accidents (RTA) in rural and urban areas based on data from the Basic Health Research 2018 (Riskesdas). Methods: This study used Riskesdas data sourced from the National Institute of Health Research and Development, Ministry of Health, Indonesia, which was collected from 34 provinces in Indonesia using a cross-sectional method. The statistical data consisted of 59,423 respondents aged over 15 years old, who had experienced a road traffic injury and lived in rural or urban areas. The data variables analysis was socio-demographic, lifestyle, smoking status, alcohol consumption, mental disorders, nutritional status and use of helmets on motorcycle riders and passengers. Statistical Analysis: Multivariate logistic regression was used to analyse the most dominant risk factors related to RTA in rural and urban areas. Results: The prevalence of RTA in urban areas was 34.1%, while in rural areas was 28.2%. The factors related to traffic accidents in respondents from urban areas (P < 0.005) were sex (1.342 [1.217-1.480]), age (1.111 [1.067-1.156]) and use of helmets on motorcycle riders and passengers (0.662 [0.566-0.771]). Meanwhile, risk factors for respondents from rural areas (P < 0.005) were mental disorders (0.842 [0.743-0.955]), age (1.095 [1.040-1.154]) and use of helmets on motorcycle riders and passengers (0.682 [0.585-0.796]). Conclusions: We found that the prevalence of RTA in urban areas was higher than in rural areas. The dominant risk factors related to RTA in Indonesia were age, sex, mental disorders and the use of helmets on motorcycle riders and passengers. This finding supports the importance of road safety education and the prevention of RTA needs to be done both in urban and rural areas.