Psychometric Properties of EQ-5D-3L Applied through Phone Follow-Ups: An Experience in PERSIAN Traffic Cohort.

Objective: To assess psychometric properties of the European Quality of Life 5-Dimension 3-Level Version (EQ-5D-3L) commonly used tool for measuring road traffic injury (RTI) patients' quality of life. Methods: The psychometric study assessed the reliability and applicability of EQ-5D-3L through phone surveys, based on a national cohort platform. Data of 150 RTI patients recruited from the cohort study were included as 50 patients per each follow-up phase (one, six, and twelve months after discharge). A 12- day-time span was between test and retest. We measured psychometric properties (internal consistency reliability and stability reliability) and agreement using Kappa coefficients and percentages of agreement and Bland-Altman method. Data were analysed using software STATA statistical package. Results: The majority of patients were men (80%) with mean age (SD) of 41(14.7%), employed (78%) and educated (86%). The Persian version represented high internal consistency reliability at total level (Cronbach's α=0.81) and moderate to good reliability at phase levels (0.62-0.87). The stability reliability was excellent at total (ICC=0.98, 95% CI: 0.97, 0.98) and phase levels (0.97-0.98. The kappa agreement coefficients were valued moderate to perfect (0.6-0.8, p>0.0001). The Bland-altman plot illustrated high agreement between test and retest scores. No floor and ceiling effects were found. Conclusion: The study revealed that EQ-5D-3L was highly reliable and responsive to be applied through phone interviews at three different times post injury and discharge, as no previous study considered its psychometric properties at various phone follow-ups after RTIs.

Psychometric properties of the 12-item WHODAS applied through phone survey: an experience in PERSIAN Traffic Cohort.

BACKGROUND: Due to limited capability to function in post-injury daily life injury, survivors need to be reliably assessed without need to commute more than necessary. The key action is to determine the level of functioning difficulties. Having the opportunity of conducting a national post-crash traffic safety and health cohort study, we aimed to translate into Persian and assess the psychometric properties of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) through phone surveys six month post injury. METHODS: First, having World Health Organization permission, we tested the translation validity by forward translation, expert panel evaluation, back-translation, pre-testing and cognitive interviewing, and finalizing the Persian WHODAS. Then, through a psychometric study within a national cohort platform, the validity, reliability and applicability of the 12-item WHODAS was assessed through phone surveys. We included data of 255 road traffic injury patients enrolled from the cohort at six-month follow-up. The psychometric assessment (internal consistency reliability and stability reliability) was conducted on test-retest data of 50 patients with an average 7-day time span. An exploratory factor analysis tested the construct validity using extraction method of principal component factor and oblique rotation on data from 255 patients. Regarding the multiple criteria including an eigenvalue > 0.9, Cattell's scree test, cumulative variance, and the theoretical basis, the minimum number of factors were retained. Data were analyzed using STATA statistical software package. RESULTS: The respondents were mostly male (81%), employed (71%), educated (87%), and with a mean age of 37.7(14.9). The Persian version had high internal consistency reliability (Cronbach's α = 0.93) and excellent stability reliability (ICC = 0.97, 95% CI: 0.92-0.98). An exploratory factor analysis retained four factors defining 86% of all the variance. Factors of Self-care, Mobility, and Cognition were completely retained. CONCLUSIONS: The brief Pesrian WHODAS 2.0 was highly reliable and valid to be applied through phone interviews post injury.

PERSIAN Traffic Safety and Health Cohort: a study protocol on postcrash mental and physical health consequences.

BACKGROUND: Cohort studies play essential roles in assessing causality, appropriate interventions. The study, Post-crash Prospective Epidemiological Research Studies in IrAN Traffic Safety and Health Cohort, aims to investigate the common health consequences of road traffic injuries (RTIs) postcrash through multiple follow-ups. METHODS: This protocol study was designed to analyse human, vehicle and environmental factors as exposures relating to postcrash outcomes (injury, disability, death, property damage, quality of life, etc). Population sources include registered injured people and followed up healthy people in precrash cohort experienced RTIs. It includes four first-year follow-ups, 1 month (phone-based), 3 months (in-person, video/phone call), 6 and 12 months (phone-based) after crash. Then, 24-month and 36-month follow-ups will be conducted triennially. Various questionnaires such as Post-traumatic Stress Disorder Questionnaire, Patient Health Questionnaire, WHO Disability Assessment Schedules, Cost-related Information, etc are completed. Counselling with a psychiatrist and a medical visit by a practitioner are provided accompanied by extra tools (simulator-based driving assessment, and psychophysiological tests). Through preliminary recruitment plan, 5807, 2905, 2247 and 1051 subjects have been enrolled, respectively at the baseline, first, second and third follow-ups by now. At baseline, cars and motorcycles accounted for over 30% and 25% of RTIs. At first follow-up, 27% of participants were pedestrians engaged mostly in car crashes. Around a fourth of injuries were single injuries. Car occupants were injured in 40% of collisions. DISCUSSION: The study provides an opportunity to investigate physical-psychosocial outcomes of RTIs, predictors and patterns at follow-up phases postinjury through longitudinal assessments, to provide advocates for evidence-based safety national policy-making.

Global School-based Student Health Survey reveals correlates of suicidal behaviors in Brunei Darussalam: a nationwide cross-sectional study.

BACKGROUND: This study aimed to determine the prevalence of and correlates for suicidal behaviors among school attending adolescents in Brunei. METHODS: Nationally representative cross-sectional data on (n=2599) adolescents derived from the Global School-based Health Survey in Brunei Darussalam were examined. Data on suicidal behaviors, psychosocial and demographic characteristics were analyzed using multiple logistic regression taking survey design into account. RESULTS: Twelve months prior to being surveyed, the prevalence of suicidal behaviors was 9.3%, 6.5% and 5.9% for suicidal ideation, suicidal plan and suicidal attempt, respectively. Females were overrepresented in attempts (61.2%). Several self-reported characteristics such as suicide ideation (69%), anxiety (28%), and loneliness (30%) were significantly different between the attempters of suicide and non-attempters (p less than 0.05). Also, some suicide-related behaviors such as having planned a suicide (52%), being bullied (21%), involved in a physical fight (29%), serious injury (29%), early sexual debut (8.5%), alcohol use at early age (21%), alcohol use in the past 30-days (12%), and being physically attacked (30%) differed by suicide category (p less than 0.05). Compared to those who did not report attempting suicide, attempters were more likely to have suicide ideation (OR=10.58; 95% CI 5.10, 21.97); have planned suicide (OR=9.82; 95% CI 4.60, 20.96); or sustained serious injury (OR=4.01; 95% CI 2.03, 7.93) within the recall period. CONCLUSIONS: This study provided evidence, which overall confirm that the psycho-social environment in school settings modify suicidal behavior. The results, taken together emphasize the importance of the school environment on the development of school attending adolescents. Where possible, the results may provide additional information on which self-reported behaviors represent avenues for potential preventive programming.

Evaluating the relationship between adult attention-deficit/hyperactivity disorder and riding behavior of motorcyclists.

BACKGROUND: Motorcycling is one of the main causes of injury, and motorcyclists are vulnerable to road traffic injuries. Attention Deficit Hyperactivity Disorder (ADHD) in adults is presumably one of the determinants of road traffic injuries and motorcyclists' risky behavior. Despite the few studies on the relationship between motorcycle injuries and adult ADHD, their association has not been investigated using standardized instruments. This study aimed to analyze the relationship between motorcyclists' adult ADHD and risky riding behaviors. METHODS: This community-based, cross-sectional study was performed on 340 motorcyclists in Bukan city, west Azerbaijan province, Iran in 2015 and 2016 using a cluster-random sampling in seven areas of the city. According to the city map used by Bukan's Health Centers, the city was divided into 14 clusters. Then, seven clusters (out of 14) were selected randomly. To reach the anticipated sample size, the data were collected from these seven clusters. In this study, the data collection instruments were: standard Motorcycle Rider Behavior Questionnaire (MRBQ), Conners' Adult ADHD Rating Scales (CAARS) questionnaire and a checklist designed by the researchers. The Stata 13 software package was used to analyze the collected data. Pearson correlation coefficient and multiple linear regression were performed to study the linear relationship between ADHD screening and MRBQ scores. RESULTS: All 340 participants were male and the mean age was 30.2 years (SD=9.1). In addition, 22.1% of motorcyclists had a history of motorcycle crash. Bivariate analysis showed a significant association between risky riding behaviors and age, motorcycling records, and mean of riding hours per day (P-value less than 0.05). Multivariate analysis confirmed the correlation between ADHD and risky riding behaviors in all subscales (A, B, D) (p less than 0.05). CONCLUSIONS: Those with a high ADHD screening score are more likely to have risky riding behaviors.

Epidemiology of Road Traffic Injury Fatalities among Car Users; A Study Based on Forensic Medicine Data in East Azerbaijan of Iran.

OBJECTIVE: To study the epidemiology of car user road traffic fatalities (CURTFs) during eight years, in East Azerbaijan, Iran. METHODS: A total of 3051 CURTFs registered in East Azerbaijan forensic medicine organization database, Iran, during 2006-2014, were analyzed using Stata 13 statistical software package. Descriptive statistics (p<0.05) and inferential statistical methods such as Chi-squared test and multivariate logistic regression with p<0.1 were applied. RESULTS: Of the 7818 road traffic injury (RTI) deaths, 3051 (39%) were car users of whom 71% were male (mean age of 36.7±18.5 years). The majority of accident mechanisms were vehicle-vehicle crashes (63.95%), followed by rollover (26.24%). Crash causing vehicle fall increased the pre-hospital death likelihood by 2.34 times. The prominent trauma causing death was head trauma (in 62.5%). In assessing the role of type of counterpart vehicle on pre-hospital mortality, considering the other cars to be the reference group for comparison, deceased victims were 1.83 times more likely to die before hospital when the counterpart vehicle was a truck and 1.66 times more for buses. CONCLUSION: Decreasing the car users' fatalities using appropriate strategies such as separating the roads for heavy and light vehicles and improving the injury related facilitation may be effective. Male drivers with low education could be prioritized for being trained.