Descriptive analysis of road traffic crashes encountered by Tanzanian motorcycle taxi drivers trained in first aid.

Introduction: In Dar es Salaam, Tanzania, death from road traffic crashes (RTC) occurs at roughly double the global rate. In this study, we sought to understand the locations and types of vehicles involved in RTC in Dar es Salaam encountered by a cohort of motorcycle taxi drivers previously trained in first aid. Methods: This was a quasi-non-randomized interventional study, cohort subtype, with three-month follow-up. Some 186 motorcycle taxi drivers were selected by convenience sampling from 16 heavily populated, central wards and trained in a basic hemorrhage control course. Participants reported the location and types of vehicles involved in RTCs they encountered and intervened upon through performing bleeding control interventions. Surveys were designed on KoboToolbox and administered via phone call at monthly intervals over a three-month period. The main outcome measures were the location of crash encounters and types of vehicles involved. Results: In all 62 unique participants (33.3 %) encountered and provided bleeding control interventions to 83 injured individuals following 69 RTC in at least 31 distinct city wards, despite training only having occurred in 16 wards. Eight crash locations were not recorded. Crashes in distant wards typically contained major roads. Most commonly, crashes involved a motorcycle without the involvement of another vehicle (n=20), followed by motorcycle vs. car/three-wheeled vehicle (n=15), motorcycle vs. bus/van (n=10), motorcycle vs. motorcycle (n=9), motorcycle vs. pedestrian (n=7), pedestrian vs. bus/van (n=2), pedestrian vs. car/three-wheeled vehicle (n=1), motorcycle vs. bicycle (n=1), multi vehicle (n=1), and other (n=3). Conclusions: Motorcycle taxi drivers trained in hemorrhage control frequently encounter and intervene upon RTC in wards where they are based as well as in distant locations, commonly in wards containing major roads. Expanding first aid training for motorcycle taxi drivers could improve timely access to emergency care for RTC victims. Since most crashes involved motorcycles, road safety training should be integrated into future courses.

Systems issues limiting acute fracture care delivery at a tertiary care hospital in Northern Tanzania.

Introduction: sub-Saharan Africa experiences a significant musculoskeletal trauma burden. Among patients who receive surgical treatment, there have been no reports as to how often surgical care is determined to be "adequate" or, if "inadequate", then what hospital and orthopaedic specialty-specific systems limitations might be prohibitive. Methods: data from patients presenting to the orthopaedic trauma service at a tertiary care center in sub-Saharan Africa were prospectively collected over a 6-week period and then retrospectively reviewed to determine whether the surgical treatment was "adequate" (or otherwise, "inadequate") according to the principle of restoring length, alignment, and rotation. Exclusion criteria included insufficient clinical information; isolated spinal injury; infection; cases involving only removal of hardware; soft-tissue procedures; tumor cases; and medical (non-surgical) conditions. Results: 112 cases were included for analysis. Surgery was indicated in 106 of 112 cases (94.6%), and of those, surgery was performed in 62 cases (58.4%). Among patients who underwent surgery with available post-operative imaging (n=56), surgical treatment was "inadequate" in 24 cases (42.9%). The most common reasons treatment was deemed "inadequate" included unavailability of appropriate implants (n=16), unavailability of intraoperative fluoroscopy (n=10) and incomplete intraoperative evaluation of injury (n=5). Conclusion: several systems limitations prevent the delivery of adequate surgical treatment in patients with acute orthopaedic traumatic injuries, including lack of intraoperative fluoroscopy and lack of implant availability. This study will serve as a useful baseline for ongoing efforts seeking to improve orthopaedic specialty resource availability and facilitate more effective fracture care in this region.

Understanding the Burden of Pediatric Traumatic Injury in Uganda: A Multicenter, Prospective Study.

INTRODUCTION: Traumatic injury is responsible for eight million childhood deaths annually. In Uganda, there is a paucity of comprehensive data describing the burden of pediatric trauma, which is essential for resource allocation and surgical workforce planning. This study aimed to ascertain the burden of non-adolescent pediatric trauma across four Ugandan hospitals. METHODS: We performed a descriptive review of four independent and prospective pediatric surgical databases in Uganda: Mulago National Referral Hospital (2012-2019), Mbarara Regional Referral Hospital (2015-2019), Soroti Regional Referral Hospital (SRRH) (2016-2019), and St Mary's Hospital Lacor (SMHL) (2016-2019). We sub-selected all clinical encounters that involved trauma. The primary outcome was the distribution of injury mechanisms. Secondary outcomes included operative intervention and clinical outcomes. RESULTS: There was a total of 693 pediatric trauma patients, across four hospital sites: Mulago National Referral Hospital (n = 245), Mbarara Regional Referral Hospital (n = 29), SRRH (n = 292), and SMHL (n = 127). The majority of patients were male (63%), with a median age of 5 [interquartile range = 2, 8]. Chiefly, patients suffered blunt injury mechanisms, including falls (16.2%) and road traffic crashes (14.7%) resulting in abdominal trauma (29.4%) and contusions (11.8%). At SRRH and SMHL, from which orthopedic data were available, 27% of patients suffered long-bone fractures. Overall, 55% of patients underwent surgery and 95% recovered to discharge. CONCLUSIONS: In Uganda, non-adolescent pediatric trauma patients most commonly suffer injuries due to falls and road traffic crashes, resulting in high rates of abdominal trauma. Amid surgical workforce deficits and resource-variability, these data support interventions aimed at training adult general surgeons to provide emergency pediatric surgical care and procedures.

Effectiveness of Interventions on Work Outcomes After Road Traffic Crash-Related Musculoskeletal Injuries: A Systematic Review and Meta-analysis.

BACKGROUND: Musculoskeletal injuries are common after road traffic crash (RTC) and can lead to poor work-related outcomes. This review evaluated the impact of interventions on work-related (e.g. sick leave), health, and functional outcomes in individuals with a RTC-related musculoskeletal injury, and explored what factors were associated with work-related outcomes. METHODS: Searches of seven databases were conducted up until 9/03/2023. Eligible interventions included adults with RTC-related musculoskeletal injuries, a comparison group, and a work-related outcome, and were in English. Meta-analyses were conducted using RevMan and meta-regressions in Stata. RESULTS: Studies (n = 27) were predominantly conducted in countries with third-party liability schemes (n = 26), by physiotherapists (n = 17), and in participants with whiplash injuries (94%). Pooled effects in favour of the intervention group were seen overall (SMD = - 0.14, 95% CI: - 0.29, 0.00), for time to return to work (- 17.84 days, 95% CI: - 24.94, - 10.74), likelihood of returning to full duties vs. partial duties (RR = 1.17, 95% CI: 1.01, 1.36), decreased pain intensity (- 6.17 units, 95% CI: - 11.96, - 0.39, 100-point scale), and neck disability (- 1.77 units, 95% CI: - 3.24, - 0.30, 50-point scale). DISCUSSION: Interventions after RTC can reduce time to return to work and increase the likelihood of returning to normal duties, but the results for these outcomes were based on a small number of studies with low-quality evidence. Further research is needed to evaluate a broader range of interventions, musculoskeletal injury types, and to include better quality work-related outcomes.

Psychosocial work conditions and traffic safety among minibus and long-bus drivers.

OBJECTIVE: This study sought to examine the association between psychosocial work factors and road traffic crashes (RTCs), and test the differences in psychosocial work factors between minibus and long-bus drivers. METHODS: This cross-sectional survey employed a convenient sampling method to collect data from 7315 long-distance minibus and long-bus drivers who operate between the Ghanaian cities, Accra and Tema and other parts of the country. The drivers answered a job content questionnaire, psychosocial safety climate scale (PSC-12), work-family conflict scale, and demographic questions on age, education, driving hours, and RTC history. RESULTS: The correlational analysis showed a significant association between psychosocial work factors and RTCs for the previous 2 years. Hierarchical multiple linear regression found that supervisor support, skill discretion, decision autonomy, psychological demands, PSC, and work-family conflict significantly contributed to explaining RTC rates among the drivers. Also, significant differences were found between minibus and long-bus drivers in driving hours, occurrence of near misses, RTCs, and all psychosocial work factors explored in this study except work-family conflict. CONCLUSIONS: Psychosocial work factors directly predict RTCs among minibus and long-bus drivers. Policymakers, driver unions, and owners and managers of bus transport businesses should prioritize integrating occupational health and safety into road transport activities. Furthermore, managers and bus owners should use bottom-up communication, provide access to support services and work-family balance initiatives, flexible work schedules, and a supportive work environment to improve road safety.

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.

Road traffic mortality in Zunyi city, China: A 10 - year data analysis (2013-2022).

PURPOSE: The study aimed to examine the pattern of motorization and the mortality rate related to road traffic crashes in Zunyi (a city in northern Guizhou province of China) from 2013 to 2022, and to identify the epidemiological characteristics of these crashes with to provide insights that could help improve road safety. METHODS: Data were obtained from the Zunyi traffic management data platform, and the mortality rates were calculated. We deployed various analytical methods, including descriptive analysis, Chi-square test or Fisher's exact test of categorical variable, circular distribution map analysis, and Rayleigh test to characterize the traits of road traffic crashes in the region. RESULTS: During the 10-year study period, 7488 people died due to road traffic accidents, with males accounting for 70.4% and females 29.6% (χ2 = 101.97, p < 0.001). The mortality rate increased from 7.80 deaths per 100,000 people in 2013 to 10.70 deaths per 100,000 people in 2016, but then decreased to 9.54 deaths per 100,000 people in 2019. A notable finding was that the death rate per 10,000 vehicles declined from 16.09 deaths per 10,000 vehicles in 2013 to 5.48 deaths per 10,000 vehicles in 2022. The study also found that vulnerable road users represented nearly half (48.76%) of all accident fatalities, and unlicensed or inexperienced driving contributed significantly to the occurrence of road traffic accidents. CONCLUSION: Although the number of road traffic accidents in Zunyi has decreased, there are still some critical issues that need to be addressed, particularly for vulnerable road users and unlicensed drivers. Our results highlight the need of targeted interventions to address the specific risk factors of road traffic crashes, particularly those affecting vulnerable road users and drivers without sufficient experience or license.

Motorcycle Road Traffic Injuries in a Tertiary Hospital in Nigeria: A Reflection of the Trauma Care Crisis.

BACKGROUND:  Motorcycle is a popular and growing form of intracity transportation in many Nigerian cities owing mainly to poorly developed transport systems. It contributes significantly to road traffic injuries (RTIs), which are a leading cause of death and disabilities in low- and middle-income countries. There is a lack of information on the quality of care received and the treatment outcome in patients with motorcycle RTIs in Ibadan and many cities in Nigeria. This study evaluated the characteristics of motorcycle-related RTIs, the quality of care received, and the outcome of the patients managed in a trauma reference center in Ibadan, Nigeria. METHODS:  This is a prospective cohort study. All patients involved in motorcycle road traffic crashes who presented to the emergency department of the University College Hospital, Ibadan, between August 2020 and May 2021, were included in the study. Data on patients' demographics, history of the crash, injuries sustained, definitive care, and the outcome of in-hospital care were obtained from patients (and/or their carers) and the medical records. RESULTS:  A total of 156 patients were seen, out of which 74.4% were males. About 76.2% were less than 45 years with a mean age of 35.7 ± 16.3 years, and the peak age group was 18-44 years. About 37 (23.7%) patients were involved in motorcycle/motorcycle collisions, whereas 67 (42.9%) were involved in motorcycle/car collisions. Riders accounted for 59.6% (93), and although 62% (97) of the patients presented within six hours of the crash, only 10.9% (17) presented within one hour. About 48% received some form of prehospital care rendered by officials of the Federal Road Safety Corps, police officers, or passers-by, and none was attended by a dedicated emergency ambulance team. The head and the limbs were the most affected anatomical areas, while orthopedic and neurosurgical procedures were the most required emergency surgical interventions. About 66.7% were discharged home with only 21.2% of them fit to return to pre-trauma function at discharge, and the mortality rate was 17.3%. Patients who presented at 7-24 hours (AOR = 2.99; 95% CI = 1.04-8.62; p-value = 0.043) and >24 hours after the accident (AOR = 5.65; 95% CI = 1.64-19.53; p-value = 0.006) were 2.99 and 5.65 times, respectively, more likely to die from motorcycle-related accident compared to those who presented within the first six hours. CONCLUSION:  This study identified the growing burden of disabilities and mortalities related to motorcycle RTIs. It highlights the lack of prehospital trauma care, which is a reflection of the deficiency of a national, regional, or jurisdictional trauma system and the critical need to develop a functional trauma system.

Spatial pattern identification and crash severity analysis of road traffic crash hot spots in Ohio.

Safety experts and transportation departments are focused on reducing road accidents and their societal and economic effects. The most crucial step in establishing a successful road safety practice is identifying dangerous highway zones through the study of crashes and looking at how the location of accidents relates to surrounding geography and other factors. Using the latest cutting-edge GIS analytical methods, this study aims to map the locations of accident hot spots and evaluate the severity and spatial extent of crash occurrences in Ohio. Road traffic crash (RTC) data has been analyzed using sophisticated GIS-based hot spot analysis for decades by safety researchers. Using four years' worth of crash data from the state of Ohio and spatial autocorrelation analysis, this study aims to show how a GIS technique can be used to find places where accidents are likely to happen (2017-2020). The study analyzed and ranked crash hotspot areas using the matching severity levels of RTCs. Cluster zones of high and low crash severity were discovered using the spatial autocorrelation tool and the Getis Ord Gi* statistics tool to evaluate the distribution of RTCs. The analysis used Getis Ord Gi*, the crash severity index, and Moran's I spatial autocorrelation of accident events. The findings indicated that these techniques were useful for identifying and rating crash hotspot locations. Since the sites of the identified accident hotspots are located in significant cities in the state of Ohio, such as Cleveland, Cincinnati, Toledo, and Columbus, the organizations in charge of traffic management should make it their top priority to minimize the negative socioeconomic impact that RTCs have and should also conduct a thorough investigation. This study's contribution is the incorporation of crash severity into hot spot analysis using GIS, which could lead to better-informed decision-making in the realm of highway safety.

Injury patterns in patients with severe traumatic brain injuries from motor crashes admitted to Mulago hospital accidents & emergency unit.

Background: The global burden of Road Traffic Crashes (RTC) is increasing. Uganda has one of the highest rates of RTCs in Sub-Sahara. Victims of RTCs sustain varying degrees of injuries depending on factors including the velocity at time of impact, protective gear; and if it was a motorcycle-motorcycle or motorcycle-vehicle crash. High speed collisions can result in severe forms of injuries and polytrauma. Some injuries are undetected. Methods: A cross sectional study was carried at Mulago Hospital Accidents & Emergency Unit, between November 2021 and February 2022; on all adult patients (≥18 years) with severe head injury from motor road traffic crashes. The study looked at injury patterns and assessed the relationship of polytrauma in patients with severe head injury to the mechanism of injury (motorcycles versus vehicles). Data were extracted from patient charts using a validated data abstraction tool and complete head to toe physical examination was carried out and injuries recorded. Data were analysed to determine the relationship of polytrauma in patients with severe head injury to the mechanism of injury. Results: The participants were predominantly males with a population median age of 32 (25-39). The commonest modes of transportation of patients to the hospital were Police Pickup trucks (40%) and ambulance (36.1%). Among motorcycle RTCs, (19.2%) wore helmets; 21.2% had protective gear; with injury identified mainly in; the limbs (84.8%), neck (76.8%), chest (39.4%), and abdomen (26.3%). Patients from vehicle RTCs were 19% more likely to have polytrauma compared to patients from motorcycle RTCs. Conclusions: This study showed that patients who sustain severe traumatic brain injuries from vehicle crashes have an increased likelihood of having multiple injuries, compared to patients from motorcycle RTCs. For motorcycle users, injuries mostly affect the limbs. At particular risk are motorcyclists who do not wear helmets and protective coveralls.

Crash-involved THC-positive drivers in Norway have a high frequency of polysubstance use.

BACKGROUND: Tetrahydrocannabinol (THC) is the most frequently detected drug in blood samples from apprehended drug driving suspects in Norway. This investigation aimed to study the extent of polysubstance use among apprehended crash-involved drivers with THC concentrations above the legal limit and explore the importance of THC in polysubstance cases. METHODS: We selected all drug driving cases where blood samples had been submitted for forensic toxicology testing after involvement in road traffic crashes during 2013-2020, except drivers who were fatally injured. RESULTS: Twenty percent (n = 2133) of the 10,520 apprehended crash-involved drivers had concentrations of THC in their blood above the legal limit of 1.3 ng/mL, and 84 % of those also had concentrations of alcohol or other drugs above the legal limits; 61 % for sedatives, 38 % for stimulants, 33 % for alcohol, and 10 % for opioids. The most frequent substance combination was cannabis together with sedatives and stimulants (22.9 %; n = 488). Polysubstance use was least common among drivers under 24 years. The proportion of drivers with THC > 5 ng/mL was highest if the blood sample was collected within 90 min after the crash, and when only THC was detected. There was a statistically significant inverse association between THC > 5 ng/mL and concentrations of alcohol or amphetamines at the highest sanction level. CONCLUSIONS: Most apprehended crash-involved THC-positive drivers also tested positive for other psychoactive substances. Drivers with high blood THC concentrations had less often high concentrations of other substances; cannabis might then have been a more important contributor to impairment.

Prescribed anti-glaucoma medication consumption and road traffic crash.

BACKGROUND: Glaucoma is one of the leading causes of visual impairment worldwide. Influence of visual defects associated with this condition, as well as potential side effects of anti-glaucoma medications on driving may be a relevant traffic safety concern. This study therefore aimed to investigate whether and/or to what extent prescribed anti-glaucoma medicine consumption is associated with increased likelihood of crash risk, and traffic crash responsibility among drivers involved in road traffic crashes. METHODS: Data from three French national databases were extracted and matched as part of the CESIR (a combination of studies on health and road safety) project. The sample included 201 497 drivers involved in an injurious road crash in France from July 1, 2005 to December 31, 2015, and an age- and sex-matched control group (113 357 drivers) that was randomly drawn from the general population. Exposure to anti-glaucoma medications were compared between responsible and non-responsible drivers involved in a crash and between drivers involved in a crash and people from the control group. RESULTS: The proportion of drivers with prescribed anti-glaucoma medicine markedly increased with age. One type (OR = 0.79, 95% CI: 0.72-0.86) and two or more types (OR = 0.82, 95% CI: 0.68-0.98) anti-glaucoma medicine prescriptions were less frequent in crash-involved drivers than in controls. One type (OR = 0.99, 95% CI: 0.88-1.12) and two or more types (OR = 1.04, 95% CI: 0.82-1.33) anti-glaucoma medicine prescriptions were not associated with crash responsibility. CONCLUSION: Our findings are reassuring as regard to existing guidelines for safe driving for individuals using anti-glaucoma medications. Our results also suggest that driving behavior adaptation is effective mitigating potential traffic crash risks for people diagnosed with glaucoma.

Evaluating feasibility of a novel mobile emergency medical dispatch tool for lay first responder prehospital response coordination in Sierra Leone: A simulation-based study.

INTRODUCTION: The global injury burden, driven by road traffic injuries, disproportionately affects low- and middle-income countries, which lack robust emergency medical services (EMS) to address injury. The WHO recommends training lay first responders (LFRs) as the first step toward formal EMS development. Emergency medical dispatch (EMD) systems are the recognized next step but whether small groups of LFRs equipped with mobile dispatch infrastructure can efficiently respond to geographically-dispersed emergencies in a timely fashion and the quality of prehospital care provided is unknown. MATERIALS AND METHODS: We piloted an EMD system utilizing a mobile phone application in Sierra Leone. Ten LFRs were randomly selected from a pool of 61 highly-active LFRs trained in 2019 and recruited to participate in an emergency simulation-based study. Ten simulation scenarios were created matching proportions of injury conditions across 1,850 previous incidents (June-December 2019). Fifty total simulations were launched in randomized order over 3 months, randomized along 10 km of highway in Makeni. Replicating real-world conditions, highly-active LFR participants were blinded to randomized dispatch timing/scenario to assess response time and skill performance under direct observation with a checklist using standardized patient actors. We used novel cost data tracked during EMD pilot implementation to inform the calculation of a new cost-effectiveness ratio ($USD cost per disability-adjusted life year averted (DALY)) for LFR programs equipped with dispatch, following WHOCHOICE guidelines, which state cost-effectiveness ratios less than gross domestic product (GDP) per capita are considered "very cost-effective." RESULTS: Median total response interval (notification to arrival) was 5 min 39 s (IQR:0:03:51, 0:09:18). LFRs initially trained with a 5-hour curriculum and refresher training provide high-quality prehospital care during simulated emergencies. Median first aid skill checklist completion was 89% (IQR: 78%, 90%). Cost-effectiveness equals $179.02USD per DALY averted per 100,000 people, less than Sierra Leonean GDP per capita ($484.52USD). CONCLUSION: LFRs equipped with mobile dispatch demonstrate appropriate response times and effective basic initial management of simulated emergencies. Training smaller cohorts of highly-active LFRs equipped with mobile dispatch appears highly cost-effective and may be a feasible model to facilitate efficient dispatch to expand emergency coverage while conserving valuable training resources in resource-limited settings.

The Burden of Geriatric Trauma at the University College Hospital, Ibadan Nigeria.

Background: Geriatric populations presently account for 9% of the world population and this is expected to increase. Injuries to the elderly accounted for 5.8 million accident and emergency visits in the US as well as 4% of patients treated for traumatic injuries in Abuja, Nigeria. Traumatic injury is therefore a major cause of morbidity in the elderly as such the need for the study in our environment. Aims and Objectives: The aim of this study was to review the incidence and types of traumatic injury among the elderly population that presented at the University College Hospital Ibadan and to determine the causes of traumatic injury involving the geriatric age group in our environment. Materials and Methods: A retrospective hospital-based study involving the records of geriatric patients that presented with traumatic injuries between January 2014 and June 2021 at the geriatric center and the accident and emergency department of the hospital. The record was retrieved from the Total Quality Management Unit of the hospital. Results: Approximately 7.61% of the traumatic injury that presented at the accident and emergency department within the study period involved geriatric patients with a male-to-female ratio of 1:1.08, whereas 0.3% of the patients for inpatient care at the geriatric center had a traumatic injury. Fall was the most common cause of traumatic injury observed and fracture was the most common traumatic injury observed. Conclusion: Less than 10% of the patients with the traumatic injury that presented at the University College Hospital Ibadan are in the geriatric age group. Most of the traumatic injury involving geriatric patients in our environment is due to low energy falls and fracture is the most common injury observed with the femur being the most affected bone. Therefore, interventions directed at reducing the incidence of falls in our environment will hopefully help in reducing the incidence of traumatic injuries in older person.

Are the Aetiologies of Traumatic Injuries Changing in Nigeria? Evidence from the Emergency Department of a Referral Hospital in Southwest Nigeria.

Background: Traumatic injuries are a serious public health problem. The burden of these injuries is increasing globally, and there is evidence that the pattern is changing. Objective: The study had two objectives. The first was to determine the aetiology and clinical spectrum of trauma in a teaching hospital. The second was to determine whether these have changed compared with previous reports from the region. Materials and Methods: Between September 2017 and August 2018, data from injured patients who presented consecutively to the accident and emergency department at the Federal Teaching Hospital Ido-Ekiti, Nigeria, were prospectively collected using a trauma data form and analysed. Results: Road traffic crashes (RTCs) caused 75.6% of the injuries, and motorcycle crashes accounted for more injuries than all the other major causes of injuries combined. Compared with previous studies from the same hospital, assault has risen to the second position, whereas falls have fallen to the third position as causes of traumatic injuries. The Injury Severity Scores (ISS) of the patients ranged from 1 to 75, with a mean score of 7.01. The mortality rate was 2.5%. Time to treatment: odds ratio (OR) = 3.25 (1.1-10.0), ISS: OR = 1.172 (1.07-1.28), age: OR = 1.097 (1.013-1.188), and systolic blood pressure: OR=1.07 (1.106-1.025) were the significant predictors of mortality. No patient was transported to the hospital in an ambulance. Conclusion: The pattern of trauma in the subregion is changing as the proportion secondary to RTCs and motorcycle crashes is higher than previously reported studies from the area. The implication of this finding for the prevention of RTCs is discussed.

Hospitalized for poverty: orthopaedic discharge delays due to financial hardship in a tertiary hospital in Northern Tanzania.

BACKGROUND: Musculoskeletal injury contributes significantly to the burden of disease in Tanzania and other LMICs. For hospitals to cope financially with this burden, they often mandate that patients pay their entire hospital bill before leaving the hospital. This creates a phenomenon of patients who remain hospitalized solely due to financial hardship. This study aims to characterize the impact of this policy on patients and hospital systems in resource-limited settings. METHODS: A mixed-methods study using retrospective medical record review and semi-structured interviews was conducted at a tertiary hospital in Moshi, Tanzania. Information regarding patient demographics, injury type, days spent in the ward after medical clearance for discharge, and hospital invoices were collected and analyzed for orthopaedic patients treated from November 2016 to June 2017. RESULTS: 346 of the 867 orthopaedic patients (39.9%) treated during this time period were found to have spent additional days in the hospital due to their inability to pay their hospital bill. Of these patients, 72 patient charts were analyzed. These 72 patients spent an average of 9 additional days in the hospital due to financial hardship (range: 1-64 days; interquartile range: 2-10.5 days). They spent an average of 112,958 Tanzanian Shillings (TSH) to pay for services received following medical clearance for discharge, representing 12.3% of the average total bill (916,840 TSH). 646 hospital bed-days were spent on these 72 patients when they no longer clinically required hospitalization. 7 (9.7%) patients eloped from the hospital without paying and 24 (33.3%) received financial assistance from the hospital's social welfare office. CONCLUSIONS: Many patients do not have the financial capacity to pay hospital fees prior to discharge. This reality has added significantly to these patients' overall financial hardship and has taken hundreds of bed-days from other critically ill patients. This single-institution, cross-sectional study provides a deeper understanding of this phenomenon and highlights the need for changes in the healthcare payment structure in Tanzania and other comparable settings.

The Prevent Alcohol and Risk-Related Trauma in Youth (P.A.R.T.Y) program: An interactive injury prevention initiative in South-Western Sydney.

BACKGROUND: The Prevent Alcohol and Risk Related Trauma in Youth (P.A.R.T.Y) program is an interactive injury prevention intervention, specifically designed for "at risk" youths aged 15 to 19 years. Emerging evidence has highlighted its positive impact on altering student attitudes towards risk-taking behaviour across several Australian and international settings. This study aims to describe the risk-taking behaviours of youths in South-Western and Greater Western Sydney, and assess the effectiveness of the Liverpool P.A.R.T.Y program to alter attitudes towards risk-taking. METHODS: From 2015 to 2020, schools and youth organisations across South-Western and Greater Western Sydney were invited to participate in the Liverpool Hospital P.A.R.T.Y program. Youths aged 15 to 19 years were selected to attend by their respective teachers based on eligibility criteria. Knowledge and attitudes towards risk-taking behaviours were measured using surveys across three time points (pre-program, immediately post-program, 3-to-6 months post-program). RESULTS: A total of 2544 participants from 50 schools and youth organisations attended the Liverpool Hospital P.A.R.T.Y program. There were 130 participants who did not record a response to a single question across all three time points and were omitted from analysis. Of the remaining 2414 participants, 49% were male, and 41% had access to a provisional driver's license or learner's permit. There were significant changes in knowledge and attitudes to risk-taking behaviours from pre-to immediately-post-program. A separate analysis across all three time points was conducted in response to a poor 3-to-6-month follow-up rate (25%). There was decay in improvements across all six questions, with the largest change seen in perceived likelihood of injury when engaging in physically risk-taking activities (52.2% to 36.9%, OR 0.44, 95% CI 0.33 - 0.60, p < 0.001). CONCLUSION: This study demonstrated significant changes in participant attitudes towards risk-taking behaviours and their consequences, immediately after participating in the Liverpool Hospital P.A.R.T.Y program. However, the poor response rates at later follow-up highlight the need for ongoing engagement of the South-Western and Greater Western Sydney youths, to ensure these improvements are sustained.

Health literacy and recovery following a non-catastrophic road traffic injury.

BACKGROUND: Health literacy (HL) is rarely addressed in rehabilitation research and practice but can play a substantial role in the recovery process after an injury. We aimed to identify factors associated with low HL and its relationship with 6-month health outcomes in individuals recovering from a non-catastrophic road traffic injury. METHODS: Four hundred ninety-three participants aged ≥17 years who had sustained a non-catastrophic injury in a land-transport crash, underwent a telephone-administered questionnaire. Information was obtained on socio-economic, pre-injury health and crash-related characteristics, and health outcomes (quality of life, pain related measures and psychological indices). Low HL was defined as scoring < 4 on either of the two scales of the Health Literacy Questionnaire that covered: ability to actively engage with healthcare providers ('Engagement' scale); and/or understanding health information well enough to know what to do ('Understanding' scale). RESULTS: Of the 493, 16.9 and 18.7% scored < 4 on the 'Understanding' and 'Engagement' scale (i.e. had low HL), respectively. Factors that were associated with low HL as assessed by both scales were: having pre-injury disability and psychological conditions; lodging a third-party insurance claim; experiencing overwhelming/great perceived sense of danger/death during the crash; type of road user; low levels of social satisfaction; higher pain severity; pain catastrophizing; and psychological- and trauma-related distress. Low HL (assessed by both scales) was associated with poorer recovery outcomes over 6 months. In these longitudinal analyses, the strongest association was with disability (p < 0.0001), and other significant associations were higher levels of catastrophizing (p = 0.01), pain severity (p = 0.04), psychological- (p ≤ 0.02) and trauma-related distress (p = 0.003), lower quality of life (p ≤ 0.03) and physical functioning (p ≤ 0.01). CONCLUSIONS: A wide spectrum of factors including claim status, pre-injury and psychological measures were associated with low HL in injured individuals. Our findings suggest that targeting low HL could help improve recovery outcomes after non-catastrophic injury.

Exploring Injured Persons' Experiences of Engaging and Using Lawyers in Road Traffic Injury Compensation Claims.

Legal services can play a critical role in facilitating claimant access to entitlements and shaping claimant experiences and outcomes in compensation settings. However, much remains unknown about claimants' goals in engaging legal services, experiences of using legal services, and satisfaction with legal advisers. Drawing on semi-structured interviews with claimants in the road traffic injury compensation scheme in the State of Victoria, Australia, this article identified that most claimants engaged legal services to access entitlements when they struggled to do so alone. Claimants often had little understanding of the activities performed by their lawyers: despite this, most viewed legal service use as valuable or worthwhile in terms of outcomes achieved. Claimants' experiences and levels of satisfaction were coloured by the quantity and quality of communication between themselves and their legal representatives. The findings highlight opportunities for schemes, lawyers, and legal profession regulators to increase the responsiveness of services to claimants' needs.

Review and Analysis of Technical Designs of Rear Underrun Protective Devices (RUPDs) in Terms of Regulatory Compliance.

The Rear Underrun Protective Device (RUPD) is a basic means to prevent a passenger car from running under the rear of a motor truck (also referred to as heavy goods vehicle or HGV) or a trailer in the case of a rear-end collision and thus to reduce deformations of the car's passenger compartment ("survival space"). In many publications dealing with such devices, the increasing of RUPD stiffness by applying innovative design solutions or using high-strength materials has been considered; in some designs, additional RUPD components are introduced to absorb the impact energy. In this paper, a review of the RUPD designs is presented and some of them are analyzed, where their characteristics that are essential for the compliance with normative market requirements are indicated. Results of the authors' research on the selection of an energy absorber incorporated in the rear impact guard bar of an HGV are presented as well.