A systematic review of risk factors associated with road traffic crashes and injuries among commercial motorcycle drivers.

To effectively reduce road traffic crashes (RTCs) and injuries interventions should be based on firm evidence regarding risk factors of RTCs and injuries in that specific population. Therefore, we undertook a systematic review to determine risk factors of RTCs and injuries among commercial motorcycle drivers. Searches were performed from inception to May 2022 in Medline, Embase, Cochrane Library, Web of Science Core Collection, PsycINFO and Cinahl, along with registers and reference lists. Inclusion criteria were commercial motorcycle drivers, quantitative observational studies, and RTCs and injuries. The search resulted in 1546 articles, of which 20 met the relevance and quality criteria. Of the 20 articles, 17 were cross-sectional, 2 were case-control studies, and one was a cohort study. Close to half of all articles (9) came from sub-Saharan Africa. Risk factors with consistent association with RTCs and injuries were young age, low education level, alcohol consumption, speeding, mobile phone use, non-helmet use, risky driving behaviours and long working hours. There was inconclusive evidence for driver's training, work schedules, motorcycle ownership, experience, dependents number, and marital status. More robust designs such as case-control or longitudinal studies are required to gain a comprehensive understanding of the antecedents of RTCs among commercial motorcycle drivers.

A stakeholder analysis of the road transport system in Tanzania using a STAMP control structure.

The way the road transport system is developed in a country affects safety. This study aims to identify the roles and relationships of road transport stakeholders and to explore the understanding of control and feedback mechanisms and associated gaps influencing road safety. A System-Theoretic Accident Model and Processes (STAMP) model was applied to document and interview data (n = 30). Participants emphasised the hindrance of overlapping mandates among stakeholders on the road transport system's operations and underlined the roles of coalitions for road safety as system enablers. Further, the withdrawal of some controls by international agencies can increase system vulnerability. Most importantly, critical control and feedback gaps were shown to increase risks for safety within the road transport system. The findings underscore the complexity of the road transport system and add to the discussion on a system's approach to road safety.Practitioner summary: Using a STAMP methodology, we extensively studied the road transport system in Tanzania. Road transport stakeholders were identified through the review of documents, interviews were conducted, and the main findings were discussed. Control and feedback mechanisms and associated gaps were critically presented, recommendations were proposed, and policy implications were suggested.

Changes in trauma-related emergency medical services during the COVID-19 lockdown in the Western Cape, South Africa.

BACKGROUND: To limit virus spread during the COVID pandemic, extensive measures were implemented around the world. In South Africa, these restrictions included alcohol and movement restrictions, factors previously linked to injury burden in the country. Consequently, reports from many countries, including South Africa, have shown a reduction in trauma presentations related to these restrictions. However, only few studies and none from Africa focus on the impact of the pandemic restrictions on the Emergency Medical System (EMS). METHODS: We present a retrospective, observational longitudinal study including data from all ambulance transports of physical trauma cases collected during the period 2019-01-01 and 2021-02-28 from the Western Cape Government EMS in the Western Cape Province, South Africa (87,167 cases). Within this timeframe, the 35-days strictest lockdown level period was compared to a 35-days period prior to the lockdown and to the same 35-days period in 2019. Injury characteristics (intent, mechanism, and severity) and time were studied in detail. Ambulance transport volumes as well as ambulance response and on-scene time before and during the pandemic were compared. Significance between indicated periods was determined using Chi-square test. RESULTS: During the strictest lockdown period, presentations of trauma cases declined by > 50%. Ambulance transport volumes decreased for all injury mechanisms and proportions changed. The share of assaults and traffic injuries decreased by 6% and 8%, respectively, while accidental injuries increased by 5%. The proportion of self-inflicted injuries increased by 5%. Studies of injury time showed an increased share of injuries during day shift and a reduction of total injury volume during the weekend during the lockdown. Median response- and on-scene time remained stable in the time-periods studied. CONCLUSION: This is one of the first reports on the influence of COVID-19 related restrictions on EMS, and the first in South Africa. We report a decline in trauma related ambulance transport volumes in the Western Cape Province as well as changes in injury patterns, largely corresponding to previous findings from hospital settings in South Africa. The unchanged response and on-scene times indicate a well-functioning EMS despite pandemic challenges. More studies are needed, especially disaggregating the different restrictions.

"I knew who I was this morning, but I've changed a few times since then": A study combining register and self-reported QoL data in assessing how response shift may occur in an injury population.

AIMS: The phenomenon of response shift may occur when people are exposed to a traumatic event and reevaluate the meaning of important aspects of their lives; a phenomenon that a traditional pre- and post-assessment cannot catch. Hence, the aim of the study was to increase the knowledge of how response shift may occur in people who have suffered an injury. METHODS: The current study is a register-based cohort study including 2512 participants. Data were retrieved from the Swedish LifeGene project and an online questionnaire, including the EQ5D. In order to analyze how response shift may occur, a "Then-test" and Structural Equation Model (SEM) were used. RESULTS: The results showed a clear indication of response shift through recalibration. The SEM analysis confirmed that participants significantly shifted their response between the post- and retrospective measurements. Significant differences were found for the VAS and for two of the five EQ5D dimensions: anxiety/depression and pain. CONCLUSION: This study provides additional knowledge to how response shift can occur in an injury population. This information can guide the next generation of QoL measures and be used as guidance for designing interventions for those suffering injuries. Furthermore, it may have an impact on how to interpret evaluations of interventions.

A pilot multicentre cluster randomised trial to compare the effect of trauma life support training programmes on patient and provider outcomes.

INTRODUCTION: Trauma accounts for nearly 10% of the global burden of disease. Several trauma life support programmes aim to improve trauma outcomes. There is no evidence from controlled trials to show the effect of these programmes on patient outcomes. We describe the protocol of a pilot study that aims to assess the feasibility of conducting a cluster randomised controlled trial comparing advanced trauma life support (ATLS) and primary trauma care (PTC) with standard care. METHODS AND ANALYSIS: We will pilot a pragmatic three-armed parallel, cluster randomised controlled trial in India, where neither of these programmes are routinely taught. We will recruit tertiary hospitals and include trauma patients and residents managing these patients. Two hospitals will be randomised to ATLS, two to PTC and two to standard care. The primary outcome will be all-cause mortality at 30 days from the time of arrival to the emergency department. Our secondary outcomes will include patient, provider and process measures. All outcomes except time-to-event outcomes will be measured both as final values as well as change from baseline. We will compare outcomes in three combinations of trial arms: ATLS versus PTC, ATLS versus standard care and PTC versus standard care using absolute and relative differences along with associated CIs. We will conduct subgroup analyses across the clinical subgroups men, women, blunt multisystem trauma, penetrating trauma, shock, severe traumatic brain injury and elderly. In parallel to the pilot study, we will conduct community consultations to inform the planning of the full-scale trial. ETHICS AND DISSEMINATION: We will apply for ethics approvals to the local institutional review board in each hospital. The protocol will be published to Clinical Trials Registry-India and ClinicalTrials.gov. The results will be published and the anonymised data and code for analysis will be released publicly.

Pedestrians' Perception of Pedestrian Bridges-A Qualitative Study in Dar es Salaam.

BACKGROUND: About 30 percent of all road traffic deaths in Tanzania involve pedestrians. As one of the strategies to protect them, pedestrian overhead bridges have been constructed across busy roads, and plans to build more bridges are in place. It has, however, been shown that such pedestrian bridges do not necessarily discourage street-level road crossing, even when pedestrians must cross multiple lanes with heavy traffic. This paper explores the perceptions of pedestrians when crossing urban roads emphasizing pedestrian bridge users. METHODS: Nineteen semi-structured interviews were conducted in situ around six pedestrian bridges in Dar es Salaam. All interviews were conducted in Swahili, recorded using digital devices, transcribed verbatim then translated into English. Content analysis was employed using qualitative data analysis software (MAXQDA). RESULTS: We identified three overarching themes, namely, I don't know if it's right or wrong, they already decided; the bridge is just a crossing facility, not for other purposes; and follow your gut feeling, even if you don't know how things will end. The results suggest that many participants prefer to look for alternative means of transport and resorted to more alternative routes just to avoid using pedestrian bridges due to bridges length and crossing time. CONCLUSION: These findings highlight the concerns caused by alternative uses of pedestrian bridges and underscore the importance of involving local communities and other stakeholders during planning.

Economic burden of road traffic injuries in sub-Saharan Africa: a systematic review of existing literature.

OBJECTIVE: This systematic review aims to explore and synthesise existing literature on the direct and indirect costs from road traffic injuries (RTIs) in sub-Saharan Africa (SSA), the quality of existing evidence, methods used to estimate and report these costs, and the factors that drive the costs. METHODOLOGY: MEDLINE, SCOPUS, ProQuest Central, Web of Science, Global Index Medicus, Embase, World Bank Group e-Library, Econlit, Google Scholar and WHO webpages were searched for relevant literature. References of selected papers were also examined for related articles. Screening was done following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles were included in this review if they were published by March 2019, written in English, conducted in SSA and reported original findings on the cost of illness or economic burden of RTIs. The results were systematically examined, and the quality assessed by two reviewers using a modified Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. RESULTS: Eleven studies met the inclusion criteria. RTIs can cost between INT$119 and 178 634 per injury and INT$486 and 12 845 per hospitalisation. Findings show variability in costing methods and inadequacies in the quality of existing evidence. Prolonged hospital stays, surgical sundries and severity of injury were the most common factors associated with cost. CONCLUSION: While available data are limited, evidence shows that the economic burden of RTIs in SSA is high. Poor quality of existing evidence and heterogeneity in costing methods limit the generalisability of costs reported.

Association between alcohol consumption, marijuana use and road traffic injuries among commercial motorcycle riders: A population-based, case-control study in Dares Salaam, Tanzania.

BACKGROUND: Alcohol consumption and psychoactive drug use are well-recognised risk factors for road traffic injuries (RTIs). Both types of use may impair and affect drivers' performance. Yet, there is limited literature on their contribution to RTIs among commercial motorcycle riders, particularly in low- and middle-income settings. This study aimed to determine the association between alcohol consumption, marijuana use and RTIs among commercial motorcycle riders in the city of Dar es Salaam, Tanzania. METHODS: We conducted a case-control study between July 2018 and March 2019. Cases (n = 164) were commercial motorcycle riders who had sustained an RTIs and attended at a hospital. Controls (n = 400) were commercial motorcycle riders who had not experienced an RTIs that led to hospital attendance during the past six months. Alcohol consumption was assessed using the Alcohol Use Disorder Identification (AUDIT) score, which classified participants as a non-drinker, normal drinker(1-7 scores) and risky drinker (scores ≥ 8). Marijuana use was assessed through self-reported use in the past year. We estimated odds ratios (ORs) using logistic regression adjusted for sociodemographic, driver-, and work-related factors. RESULTS: Risky drinking was associated with close to six times the odds of RTIs compared to non-drinkers (OR = 5.98, 95% CI: 3.25 - 11.0). The association remained significant even after adjusting for sociodemographic, driving and work-related factors (OR = 2.41, 95% CI: 1.01 - 5.76). The crude odds ratios of RTIs were significantly higher among users of marijuana than non-users (OR = 2.33, 95% CI: 1.38 - 3.95). However, the association did not remain statistically significant after adjusting for confounders (OR = 1.11, 95% CI = 0.49-2.48). CONCLUSION: Our findings confirm increased odds of RTIs among commercial motorcycle riders with risky drinking behaviour even after taking sociodemographic, driving and work-related factors into account. Unlike alcohol consumption the relationship between marijuana use and RTIs among commercial motorcycle riders was unclear. Since motorcycle riders are more susceptible to the effect of alcohol due to higher demands of balance and coordination and because commercial motorcyclist riders, in particular, they spend a considerable amount of time on the road, our results underscore the importance of addressing hazardous alcohol consumption and marijuana use in future prevention strategies to enhance road safety.

Investigation of road infrastructure and traffic density attributes at high-risk locations for motorcycle-related injuries using multiple correspondence and cluster analysis in urban Tanzania.

Rapid growth in use of motorcycles combined with limited road infrastructures has increased the burden of road traffic crashes and injuries in low-and middle-income countries. The aim of this study was to assess whether high-risk locations for motorcycle-related injuries identified from police crash data registers for the period 2016 to 2017 share similar road infrastructure and traffic density attributes in Dar es Salaam city. Analysis was performed using multiple correspondence and hierarchical cluster analysis. Three distinct clusters for motorcycle injury hotspots were identified. Clusters 1 and 2 were associated with more fatal and severe injuries and were characterized by overrepresentation of trunk roads, unseparated two-way roads, mixture of road users and commercial and residential areas compared to Cluster 3. Cluster3 was associated with less severe injuries compared to clusters 1 and 2 (p < 0.001). Cluster 3 was characterized by overrepresentation of feeder/street roads, separated two-way roads and presence of traffic control measures. The clusters of hotspots differed by road infrastructure and traffic density attributes. Clusters 1 and 2 were characterized by more dangerous road environments, while cluster 3 was characterized by road environments with less severe outcomes. These findings can assist in prioritizing preventive strategies for motorcycle- related injuries.

Return to work and sick leave patterns following a work injury among young adults: a study protocol of a Swedish multimodal study.

INTRODUCTION: There is a lack of studies that focus exclusively on return to work (RTW) and sick leave patterns following a work injury among young adults. This study aims to close the gap by contributing with knowledge regarding young adults' sick leave pattern after a work injury and their experience of RTW after a work injury in Sweden. METHODS AND ANALYSIS: The present study is a multimodal study, which will use Swedish national register data and qualitative data collection by photovoice. Injuries classified as work injuries according to the Swedish injury classification were included. Registry data will be retrieved from the Swedish National-based registers of Swedish Information System on Occupational Accidents and Work-related diseases, the Swedish Social Insurance Agency's database MicroData for Analysis of Social Insurance and the Swedish Longitudinal Integration Database for Health Insurance and Labour Market Studies. Persons who have registered a work injury at the Swedish Work Environment Authority in 2012 will be included. Sick leave patterns will be analysed using group-based trajectory models and multivariate analyses to explore how sick leave patterns have developed over 5 years. Subsequently, a participatory approach using photovoice method will be conducted to explore young adults' perceptions of barriers and facilitators in RTW after a work injury. Results from the photovoice group sessions will be analysed using a grounded theoretical approach. ETHICS AND DISSEMINATION: The study has been reviewed and approved by the Ethical Review Board (case number 2019/028-6) in Sweden. Results of the study will be disseminated through peer-reviewed journals, print and media presentation, conferences and via reports to the funding agency.

Association between maternal and paternal mental illness and risk of injuries in children and adolescents: nationwide register based cohort study in Sweden.

OBJECTIVE: To determine the association between parental mental illness and the risk of injuries among offspring. DESIGN: Retrospective cohort study. SETTING: Swedish population based registers. PARTICIPANTS: 1 542 000 children born in 1996-2011 linked to 893 334 mothers and 873 935 fathers. EXPOSURES: Maternal or paternal mental illness (non-affective psychosis, affective psychosis, alcohol or drug misuse, mood disorders, anxiety and stress related disorders, eating disorders, personality disorders) identified through linkage to inpatient or outpatient healthcare registers. MAIN OUTCOME MEASURES: Risk of injuries (transport injury, fall, burn, drowning and suffocation, poisoning, violence) at ages 0-1, 2-5, 6-9, 10-12, and 13-17 years, comparing children of parents with mental illness and children of parents without mental illness, calculated as the rate difference and rate ratio adjusted for confounders. RESULTS: Children with parental mental illness contributed to 201 670.5 person years of follow-up, while children without parental mental illness contributed to 2 434 161.5 person years. Children of parents with mental illness had higher rates of injuries than children of parents without mental illness (for any injury at age 0-1, these children had an additional 2088 injuries per 100 000 person years; number of injuries for children with and without parental mental illness was 10 235 and 72 723, respectively). At age 0-1, the rate differences ranged from 18 additional transport injuries to 1716 additional fall injuries per 100 000 person years among children with parental mental illness compared with children without parental mental illness. A higher adjusted rate ratio for injuries was observed from birth through adolescence and the risk was highest during the first year of life (adjusted rate ratio at age 0-1 for the overall association between any parental mental illness that has been recorded in the registers and injuries 1.30, 95% confidence interval 1.26 to 1.33). Adjusted rate ratios at age 0-1 ranged from 1.28 (1.24 to 1.32) for fall injuries to 3.54 (2.28 to 5.48) for violence related injuries. Common and serious maternal and paternal mental illness was associated with increased risk of injuries in children, and estimates were slightly higher for common mental disorders. CONCLUSIONS: Parental mental illness is associated with increased risk of injuries among offspring, particularly during the first years of the child's life. Efforts to increase access to parental support for parents with mental illness, and to recognise and treat perinatal mental morbidity in parents in secondary care might prevent child injury.

m-Health for Burn Injury Consultations in a Low-Resource Setting: An Acceptability Study Among Health Care Providers.

Introduction:The rapid adoption of smartphones, especially in low- and middle-income countries, has opened up novel ways to deliver health care, including diagnosis and management of burns. This study was conducted to measure acceptability and to identify factors that influence health care provider's attitudes toward m-health technology for emergency care of burn patients.Methods:An extended version of the technology acceptance model (TAM) was used to assess the acceptability toward using m-health for burns. A questionnaire was distributed to health professionals at four hospitals in Dar Es Salaam, Tanzania. The questionnaire was based on several validated instruments and has previously been adopted for the sub-Saharan context. It measured constructs, including acceptability, usefulness, ease of use, social influences, and voluntariness. Univariate analysis was used to test our proposed hypotheses, and structural equation modeling was used to test the extended version of TAM.Results:In our proposed test-model based on TAM, we found a significant relationship between compatibility-usefulness and usefulness-attitudes. The univariate analysis further revealed some differences between subgroups. Almost all health professionals in our sample already use smartphones for work purposes and were positive about using smartphones for burn consultations. Despite participants perceiving the application to be easy to use, they suggested that training and ongoing support should be available. Barriers mentioned include access to wireless internet and access to hospital-provided smartphones.

Determinants of speeding among new generations of car drivers from the Arabian Peninsula. An investigation based among Omani drivers using the theory of planned behaviour.

In high-income countries of the Arabian Peninsula, including the Sultanate of Oman, motorization has been extremely rapid. As a result, road traffic crashes are by far the highest cause of premature mortality, and speeding is an acknowledged key risk factor. Theory-based interventions are needed to target prevention of this unsafe practice. This study sheds light on determinants of speeding among new generations of Omani drivers applying the Theory of Planned Behaviour (TPB). A questionnaire covering all five main constructs of the TPB was first contextualized and administered to two target groups: male drivers of all ages (n = 1107) approached in person when renewing their driving license and university students drivers (men and women) reached through internet contact (n = 655). Multiple, stepwise linear regression analyses were used to explore factors associated with speeding. Results indicate that driving fast and not respecting the posted speed limits was common in both groups of drivers, although rates were higher among students; 41.8% reported driving a bit faster than other drivers and 24.1% faster than the posted speed limit compared with 31.4% and 14.2% in male drivers of all ages. In both groups the TPB model predicted to a limited extent the determinants of speeding behaviour. However, the intention to speed was associated with a negative attitude towards the respect of rules for men of all ages (ß = -0.30 (p<0.001)) and for students (ß = -0.26 (p<0.001)); a positive view regarding subjective norms (ß = 0.25 (p<0.001) and ß = 0.28 (p<0.001) respectively), and behavioural control (ß = 0.15 (p<0.001) and ß = 0.20 (p<0.001) respectively). Intention was the only significant predictor of speeding behaviour (ß = 0.48 (p<0.001); and ß = 0.64 (p<0.001)). To conclude, speeding is widespread among Omani drivers of all ages and the intention to respect posted speed limits meets a range of barriers that need greater consideration in order to achieve a better safety culture in the country.

Quality of life in the limelight: a study protocol of a Swedish register-based cohort study on quality of life after an injury.

INTRODUCTION: Currently, there are very few published studies on preinjury and postinjury assessments of quality of life (QoL) based on a prospective appraisal; specifically, knowledge of those who do not seek medical care following injury is lacking. To close these knowledge gaps, this study aims to identify the psychosocial consequences in terms of loss of QoL following injury in a Swedish population and to investigate the response shift in retrospective measures of self-reported QoL. METHODS AND ANALYSIS: We will analyse preinjury and postinjury (including both minor and severe unintentional injuries as well as different injury mechanisms) assessments of QoL, including the phenomenon of response shift, using register-based data from the nationwide collaboration project LifeGene, which includes over 52 000 individuals living in Sweden. In addition to LifeGene data, a short online survey including a 'ThenTest' questionnaire, that is, comparison of previous QoL to current using EuroQoL five-dimensional questionnaire, was sent out to the participants of LifeGene. This study will provide a unique opportunity to study the changes in QoL by comparing preinjury and postinjury assessments using a prospective appraisal, both for populations who have sought medical care as well as those who have not due to their injury. Similarly, the study will also assess the response shift in retrospective measures of QoL. This information can guide the next generation of QoL measures and interventions for those suffering injuries and have an impact on how to interpret evaluations of interventions. ETHICS AND DISSEMINATION: The study has been reviewed and approved by the Regional Ethical Review Board in Stockholm, Sweden (case number 2018/352-31). The results will be disseminated through peer-reviewed journals, conference presentations, print media and internet and via a report for the funding agency.

Trajectories of sickness absence after road traffic injury: a Swedish register-based cohort study.

OBJECTIVES: Despite much focus on the health impact of road traffic injury (RTI) on life, there is a lack of knowledge of the dynamic process of return to work following RTI and its related factors. The aim of this study was to identify longitudinal patterns of sickness absence (SA) following RTI, to examine the patterns' interplay with health-related quality of life (HRQoL) and to determine if there are differences, regarding the patterns and interplay, according to injury severity. DESIGN: A register-based prospective cohort study. SETTING: Administrative data on RTI in Sweden from the Swedish Traffic Accident Data Acquisition System (STRADA) and Swedish Social Insurance data. PARTICIPANTS: Individuals suffering an RTI (total n=4761) were identified in STRADA between 1 January 2007 and 31 December 2009. A total of 903 of these met the inclusion criteria for the current study and were included. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was SA following RTI. The secondary outcome measure was HRQoL. RESULTS: Three distinct patterns of SA were identified; 'Stable', 'Quick decrease' and 'Gradual decrease'. The patterns differed in the number of initial SA days and the rate of reduction of SA days. After 3 years, all three patterns had almost the same level of SA. Higher injury severity and a higher number of SA days had a negative interplay with HRQoL. Participants who initially had a higher number of SA days were more likely to report a low HRQoL, indicating that people with a slower return to work are more vulnerable. CONCLUSION: The study highlights the heterogeneity of return to work after an RTI. People with a more severe injury and slower pace of return to work seem to be more vulnerable with regards to HRQoL loss following RTI.

I did NOT feel like this at all before the accident: do men and women report different health and life consequences of a road traffic injury?

BACKGROUND: Worldwide, injuries represent one of the leading causes of mortality, and nearly one-quarter of all injuries are road traffic related. In many high-income countries, the burden of road traffic injuries (RTIs) has shifted from premature death to injury and disability with long-term consequences; therefore, it is important to assess the full burden of an RTI on individual lives. OBJECTIVE: To describe how men and women with minor and moderate injuries reported the consequences of an RTI on their health and lives. METHODS: The study was designed as an explorative qualitative study, in which the answers to an open-ended question concerning the life and health consequences following injury were analysed using systematic text condensation. PARTICIPANTS: A total of 692 respondents with a minor or a moderate injury were included. RESULTS: The respondents reported the consequences of the crash on their health and lives according to four categories: physical consequences, psychological consequences, everyday life consequences and financial consequences. The results show that medically classified minor and moderate injuries have detrimental long-term health and life consequences. Although men and women report some similar consequences, there are substantial differences in their reported psychological and everyday life consequences following an injury. Women report travel anxiety and PTSD-like symptoms, being life altering for them compared with men, for whom these types of reports were missing. CONCLUSION: These differences emphasise the importance of considering gender-specific physical and psychological consequences following an RTI.

Teleconsultation Using Mobile Phones for Diagnosis and Acute Care of Burn Injuries Among Emergency Physicians: Mixed-Methods Study.

BACKGROUND: The referral process in acute care remains challenging in many areas including burn care. Mobile phone apps designed explicitly for medical referrals and consultations could streamline the referral process by using structured templates and integrating features specific to different specialties. However, as these apps are competing with commercial chat services, usability becomes a crucial factor for successful uptake. OBJECTIVE: The aim of this study was to assess the usability of a mobile phone app for remote consultations and referrals of burn injuries. METHODS: A total of 24 emergency doctors and 4 burns consultants were recruited for the study. A mixed-methods approach was used including a usability questionnaire and a think-aloud interview. Think-aloud sessions were video-recorded, and content analysis was undertaken with predefined codes relating to the following 3 themes: ease of use, usefulness of content, and technology-induced errors. RESULTS: The users perceived the app to be easy to use and useful, but some problems were identified. Issues relating to usability were associated with navigation, such as scrolling and zooming. Users also had problems in understanding the meaning of some icons and terminologies. Sometimes, some users felt limited by predefined options, and they wanted to be able to freely express their clinical findings. CONCLUSIONS: We found that users faced problems mainly with navigation when the app did not work in the same way as the other apps that were frequently used. Our study also resonates with previous findings that when using standardized templates, the systems should also allow the user to express their clinical findings in their own words.

Accuracy of acute burns diagnosis made using smartphones and tablets: a questionnaire-based study among medical experts.

BACKGROUND: Remote assistance for burns by medical experts can support nurses and general physicians in emergency care with diagnostic and management advice. Previous studies indicate a high diagnostic accuracy based on images viewed on a computer screen, but whether image-based analysis by experts using handheld devices is accurate remains to be determined. METHOD: A review of patient data from eight emergency centres in the Western Cape, South Africa, revealed 10 typical cases of burns commonly seen in children and adults. A web-based questionnaire was created with 51 images of burns representing those cases. Burns specialists from two countries (South Africa and Sweden (n = 8 and 7 respectively)) and emergency medicine specialists from South Africa (n = 11) were contacted by email and asked to assess each burn's total body surface area (TBSA) and depth using a smartphone or tablet. The accuracy and inter-rater reliability of the assessments were measured using intraclass correlation coefficients (ICC), both for all cases aggregated and for paediatric and adult burn cases separately. Eight participants repeated the questionnaire on a computer and intra-rater reliability was calculated. RESULTS: The assessments of TBSA are of high accuracy all specialists aggregated (ICC = 0.82 overall and 0.81 for both child and adult cases separately) and remain high for all three participant groups separately. The burn depth assessments have low accuracy all specialists aggregated, with ICCs of 0.53 overall, 0.61 for child and 0.46 for adult cases. The most accurate assessments of depth are among South African burns specialists (reaching acceptable for child cases); the other two groups' ICCs are low in all instances. Computer-based assessments were similar to those made on handheld devices. CONCLUSION: As was the case for computer-based studies, burns images viewed on handheld devices may be a suitable means of seeking expert advice even with limited additional information when it comes to burn size but less so in the case of burn depth. Familiarity with the type of cases presented could facilitate image-based diagnosis of depth.

Quality of life following road traffic injury: A systematic literature review.

PURPOSE: To assess and provide a systematic overview of current knowledge about the relationship between quality of life (QoL) and road traffic injury, and to appraise how QoL is affected by road traffic injury. METHODS: A systematic review of the literature published since 1990 on QoL after a road traffic injury, including adult and paediatric populations, from three databases (Pubmed, PsychInfo and SafetyLit) was undertaken. The methodological quality was assessed according to the Newcastle-Ottawa Quality Assessment Scale. RESULTS: Thirty articles were included and assessed for quality. The QoL scores of those injured were similar to population norms at the first assessment, followed by a drop at the second assessment. An increase of QoL from the second to third assessment was reported, but participants never reached the population norms at the last follow-up (range six weeks to two years), with an exception of those claiming compensation and those with lower extremity fractures. Age, gender, socioeconomic status, injury severity, injury type and post-traumatic stress disorder were associated with reduced QoL. CONCLUSIONS: Available literature regarding QoL among injured in road traffic crashes is heterogeneous with regard to aims and tools used for assessment. Our review confirmed that independent of measure, the overall QoL was significantly reduced after a road traffic injury compared to the general population norms. Persons who are older, of female gender, lower socioeconomic status, diagnosed with post-traumatic stress disorder, with more severe injuries or injuries to the lower limbs are more vulnerable to loss of QoL following road traffic injury compared to other patient groups injured in road traffic crashes.

A roadmap for the implementation of mHealth innovations for image-based diagnostic support in clinical and public-health settings: a focus on front-line health workers and health-system organizations.

BACKGROUND: Diagnostic support for clinicians is a domain of application of mHealth technologies with a slow uptake despite promising opportunities, such as image-based clinical support. The absence of a roadmap for the adoption and implementation of these types of applications is a further obstacle. OBJECTIVES: This article provides the groundwork for a roadmap to implement image-based support for clinicians, focusing on how to overcome potential barriers affecting front-line users, the health-care organization and the technical system. METHODS: A consensual approach was used during a two-day roundtable meeting gathering a convenience sample of stakeholders (n = 50) from clinical, research, policymaking and business fields and from different countries. A series of sessions was held including small group discussions followed by reports to the plenary. Session moderators synthesized the reports in a number of theme-specific strategies that were presented to the participants again at the end of the meeting for them to determine their individual priority. RESULTS: There were four to seven strategies derived from the thematic sessions. Once reviewed and prioritized by the participants some received greater priorities than others. As an example, of the seven strategies related to the front-line users, three received greater priority: the need for any system to significantly add value to the users; the usability of mHealth apps; and the goodness-of-fit into the work flow. Further, three aspects cut across the themes: ease of integration of the mHealth applications; solid ICT infrastructure and support network; and interoperability. CONCLUSIONS: Research and development in image-based diagnostic pave the way to making health care more accessible and more equitable. The successful implementation of those solutions will necessitate a seamless introduction into routines, adequate technical support and significant added value.