Differences in outcomes of mandatory motorcycle helmet legislation by country income level: A systematic review and meta-analysis.

BACKGROUND: The recent Lancet Commission on Legal Determinants of Global Health argues that governance can provide the framework for achieving sustainable development goals. Even though over 90% of fatal road traffic injuries occur in low- and middle-income countries (LMICs) primarily affecting motorcyclists, the utility of helmet laws outside of high-income settings has not been well characterized. We sought to evaluate the differences in outcomes of mandatory motorcycle helmet legislation and determine whether these varied across country income levels. METHODS AND FINDINGS: A systematic review and meta-analysis were completed using the PRISMA checklist. A search for relevant articles was conducted using the PubMed, Embase, and Web of Science databases from January 1, 1990 to August 8, 2021. Studies were included if they evaluated helmet usage, mortality from motorcycle crash, or traumatic brain injury (TBI) incidence, with and without enactment of a mandatory helmet law as the intervention. The Newcastle-Ottawa Scale (NOS) was used to rate study quality and funnel plots, and Begg's and Egger's tests were used to assess for small study bias. Pooled odds ratios (ORs) and their 95% confidence intervals (CIs) were stratified by high-income countries (HICs) versus LMICs using the random-effects model. Twenty-five articles were included in the final analysis encompassing a total study population of 31,949,418 people. There were 17 retrospective cohort studies, 2 prospective cohort studies, 1 case-control study, and 5 pre-post design studies. There were 16 studies from HICs and 9 from LMICs. The median NOS score was 6 with a range of 4 to 9. All studies demonstrated higher odds of helmet usage after implementation of helmet law; however, the results were statistically significantly greater in HICs (OR: 53.5; 95% CI: 28.4; 100.7) than in LMICs (OR: 4.82; 95% CI: 3.58; 6.49), p-value comparing both strata < 0.0001. There were significantly lower odds of motorcycle fatalities after enactment of helmet legislation (OR: 0.71; 95% CI: 0.61; 0.83) with no significant difference by income classification, p-value: 0.27. Odds of TBI were statistically significantly lower in HICs (OR: 0.61, 95% CI 0.54 to 0.69) than in LMICs (0.79, 95% CI 0.72 to 0.86) after enactment of law (p-value: 0.0001). Limitations of this study include variability in the methodologies and data sources in the studies included in the meta-analysis as well as the lack of available literature from the lowest income countries or from the African WHO region, in which helmet laws are least commonly present. CONCLUSIONS: In this study, we observed that mandatory helmet laws had substantial public health benefits in all income contexts, but some outcomes were diminished in LMIC settings where additional measures such as public education and law enforcement might play critical roles.

Tightening legal restrictions for drivers with epilepsy in Japan.

Epilepsy is a highly prevalent condition around the world, and many countries impose restrictions on drivers with epilepsy. After toughening the law in Japan, the number of refused driving license applications for patients with epilepsy increased markedly. However, the number of collisions caused by drivers with epilepsy did not decrease.

Road traffic injury mortality and morbidity by country development status, 2011-2017.

PURPOSE: This research examined road traffic injury mortality and morbidity disparities across of country development status, and discussed the possibility of reducing country disparities by various actions to accelerate the pace of achieving Sustainable Development Goals target 3.6 - to halve the number of global deaths and injuries from road traffic accidents by 2020. METHODS: Data for road traffic mortality, morbidity, and socio-demographic index (SDI) were extracted by country from the estimates of the Global Burden of Disease study, and the implementation of the three types of national actions (legislation, prioritized vehicle safety standards, and trauma-related post-crash care service) were extracted from the Global Status Report on Road Safety by World Health Organization. We fitted joinpoint regression analysis to identify and quantify the significant rate changes from 2011 to 2017. RESULTS: Age-adjusted road traffic mortality decreased substantially for all the five SDI categories from 2011 to 2017 (by 7.52%-16.08%). Age-adjusted road traffic mortality decreased significantly as SDI increased in the study time period, while age-adjusted morbidity generally increased as SDI increased. Subgroup analysis by road user yielded similar results, but with two major differences during the study period of 2011 to 2017: (1) pedestrians in the high SDI countries experienced the lowest mortality (1.68-1.90 per 100,000 population) and morbidity (110.45-112.72 per 100,000 population for incidence and 487.48-491.24 per 100,000 population for prevalence), and (2) motor vehicle occupants in the high SDI countries had the lowest mortality (4.07-4.50 per 100,000 population) but the highest morbidity (428.74-467.78 per 100,000 population for incidence and 1025.70-1116.60 per 100,000 population for prevalence). Implementation of the three types of national actions remained nearly unchanged in all five SDI categories from 2011 to 2017 and was consistently stronger in the higher SDI countries than in the lower SDI countries. Lower income nations comprise the heaviest burden of global road traffic injuries and deaths. CONCLUSION: Global road traffic deaths would decrease substantially if the large mortality disparities across country development status were reduced through full implementation of proven national actions including legislation and law enforcement, prioritized vehicle safety standards and trauma-related post-crash care services.

Keg Registration Laws, Alcohol Consumption, and Alcohol-Related Traffic Fatalities Among Adolescents.

OBJECTIVE: This study investigated the effect of keg registration laws on alcohol consumption and alcohol-related traffic fatalities in the United States. METHOD: The 1993-2013 data from Youth Risk Behavior Surveillance System (n = 107,480) and Fatality Analysis Reporting System (n = 12,102) and difference-in-differences type models were used to estimate the effect of keg registration laws on different indicators of alcohol consumption and alcohol-related traffic fatalities among underage youth. RESULTS: Introduction of keg registration laws was associated with a 2.3 percentage point reduction (p < .01) in heavy episodic drinking among minors. The significant effects of these laws were mainly driven by the states with relatively strict keg registration laws. However, these laws did not have a significant impact on alcohol-related traffic fatalities among underage youth. These results were robust under alternative model specifications. CONCLUSIONS: We found that keg registration laws are effective in reducing heavy episodic drinking among underage youth. This result is important given that an increasing number of states have adopted keg registration laws in recent years, yet the empirical evidence of the effectiveness of this policy is quite limited.

COVID-19 lockdown and fatal motor vehicle collisions due to speed-related traffic violations in Japan: a time-series study.

Between March and May 2020, Japan experienced a lockdown due to the COVID-19 crisis. Empty roads possibly triggered speed-related traffic violations that caused fatal motor vehicle collisions (MVCs). Using police data on the monthly number of fatal MVCs between January 2010 and February 2020 in which motor vehicle drivers were at fault, we forecasted the numbers of fatal MVCs due to the speed-related violations during the lockdown and compared these with those observed. We also compared the observed to forecasted using the ratio of the number of speed-related fatal MVCs to that of non-speed related fatal MVCs. The observed numbers of speed-related fatal MVCs were within the 95% CIs of the forecasted numbers. The observed ratio was higher than the forecasted ratio in April (p=0.016). In the second month of the lockdown, drivers were more likely to commit speed-related violations that caused fatal MVCs than before the lockdown.

Evaluation of a population health strategy to reduce distracted driving: Examining all "Es" of injury prevention.

BACKGROUND: Cell phone use while driving (CPWD) increases the risk of crashing and is a major contributor to injuries and deaths. The objective of this study was to describe the evaluation of a multifaceted, evidence-based population health strategy for the reduction of distracted driving. METHODS: A multipronged campaign was undertaken from 2014 to 2016 for 16- to 44-year-olds, based on epidemiology, focused on personal stories and consequences, using the "Es" of injury prevention (epidemiology, education, environment, enforcement, and evaluation). Education consisted of distracted driving videos, informational cards, a social media AdTube campaign, and a movie theater trailer, which were evaluated with a questionnaire regarding CPWD attitudes, opinions, and behaviors. Spatial analysis of data within a geographic information system was used to target advertisements. A random sample telephone survey evaluated public awareness of the campaign. Increased CPWD enforcement was undertaken by police services and evaluated by ARIMA time series modeling. RESULTS: The AdTube campaign had a view rate of >10% (41,101 views), slightly higher for females. The top performing age group was 18- to 24-year-olds (49%). Our survey found 61% of respondents used handheld CPWD (14% all of the time) with 80% reporting our movie trailer made them think twice about future CPWD. A stakeholder survey and spatial analysis targeted our advertisements in areas of close proximity to high schools, universities, near intersections with previous motor vehicle collisions, high traffic volumes, and population density. A telephone survey revealed that 41% of the respondents were aware of our campaign, 17% from our print and movie theater ads and 3% from social media. Police enforcement campaign blitzes resulted in 160 tickets for CPWD. Following campaign implementation, there was a statistically significant mean decrease of 462 distracted driving citations annually (p = 0.001). CONCLUSION: A multifaceted, evidence-based population health strategy using the Es of injury prevention with interdisciplinary collaboration is a comprehensive method to be used for the reduction of distracted driving. LEVEL OF EVIDENCE: Therapeutic, level IV.

Are Countries' Drink-Driving Policies Associated With Harms Involving Another Driver's Impairment?

INTRODUCTION: International drink-driving policy research generally focuses on aggregate outcomes (e.g., rates of crashes, fatalities) without emphasizing secondhand alcohol-related vehicular harms. In contrast, we investigate associations between drink-driving policies and harms involving another driver's impairment. METHODS: Alcohol's harms to others (AHTO) survey data from 12 countries (analytic N = 29,616) were linked to national alcohol policy data from the World Health Organization. We examined separately associations of two 12-month driving-related AHTOs (passenger with an impaired driver; vehicular crash involving someone else's drink driving) with 3 national drinking-driving policies-legal blood alcohol concentration (BAC) limits, use of random breath testing, use of sobriety checkpoints, and comprehensive penalties for drink-driving (community service, detention, fines, ignition interlocks, license suspension/revocation, mandatory alcohol treatment, vehicle impoundment, and penalty point system), plus 2 alcohol tax variables (having excise taxes and value-added tax [VAT] rate). Multilevel logistic regression addressed clustering of individuals within countries and subnational regions, while adjusting for individuals' gender, age, marital status, risky drinking, and regional drinking culture (% male risky drinkers in sub-national region). RESULTS: Controlling for national-, regional-, and individual-level covariates, comprehensive penalties were significantly and negatively associated with both outcomes; other vehicular policy variables were not significantly associated with either outcome. A society's VAT rate was negatively associated with riding with a drunk driver. Regional male drinking culture was positively associated with riding with an impaired driver, but was not significantly associated with being in a vehicular crash due to someone else's drinking. In both models, being male, being younger, and engaging in risky drinking oneself each were positively associated with vehicular harms due to someone else's drinking. CONCLUSIONS: Although results are associational and not causal, comprehensive penalties may be promising policies for mitigating driving-related harms due to another drinker. Higher VAT rate might reduce riding with a drunk driver.

Hit-and-runs more common with pedestrians lying on the road: Analysis of a nationwide database in Japan.

PURPOSE: To determine the trends with fatally or otherwise injured pedestrians lying on the road and the relationship to hit-and-run incidents in Japan. METHODS: We extracted data for 2012-2016 from the records of the Institute for Traffic Accident Research and Data Analysis, Japan, a nationwide traffic accident database. All the injured and fatally injured pedestrians were selected. We examined the levels of pedestrian injury, vehicle speed immediately before the collision, whether or not the pedestrian was lying on the road, and hit-and-run incidents. Chi-square test was employed to make a statistical comparison between the two groups. RESULTS: The database contained data on 286,383 pedestrian casualties and 7256 fatalities; 8.3% of fatalities (602 persons) and 0.6% of casualties (1827 persons) involved pedestrians lying on the road. The rates of fatalities and severe injuries were significantly higher for pedestrians who were lying on the road than for those who were not. Hit-and-run incidents were evident in 4.0% of casualties and 7.3% of fatalities. The rate of hit-and-run cases was also significantly higher among pedestrians who were lying on the road. Among fatally injured pedestrians not lying on the road, the rates with speeds of ≥30 km/h did not differ significantly between hit-and-run and other cases. However, when the pedestrians were lying on the road, the rate was significantly increased in hit-and-run cases. CONCLUSION: This is the first report to focus on pedestrians lying on the road and being involved in hit-and-run incidents. In addition to preventing hit-and-run incidents, prevention of pedestrians lying on the road could also decrease fatalities.

Cost analysis of road traffic crashes in China.

Fatalities and injuries resulting from road traffic crashes is always a serious problem. The overall economic losses caused by road traffic crashes are beyond imagination. Including the economic cost of property damage, productivity loss, medical cost, travel delay time cost, legal cost and insurance cost, the total economic cost of traffic crashes in China in 2017 is calculated as 490.1 billion yuan (72.6 billion USD 2017), which is equivalent to 0.60% of the GDP. The cost of productivity loss accounts for the highest proportion of total economic cost, which is 72%. The second is the travel delay cost, accounting for 12% insurance cost, property damage cost and medical cost are followed. The more serious the injury, the higher the unit economic cost. The unit cost of a crash that caused only property damage is 11,274 yuan. The unit cost of a minor injured crash is 20,223 yuan. The highest unit economic cost is the unit cost of a fatal crash, which is 3,181,394 yuan. This study provides important insights into the cost-benefit analysis of China's road safety policies.

Evaluación de las periciales extrajudiciales en Cataluña (España) en 2016-2017 / Evaluation of extrajudicial expert advice in Catalonia (Spain) in 2016-2017

INTRODUCCIÓN: Desde la entrada en vigor de la Ley 35/2015, los Institutos de Medicina Legal y Ciencias Forenses realizan periciales extrajudiciales a petición de particulares para la resolución de las reclamaciones por accidentes de circulación. El objetivo es analizar los aspectos médico-legales más relevantes de estas periciales. MATERIAL Y MÉTODO: Se trata de un estudio descriptivo retrospectivo de las periciales extrajudiciales en las divisiones de Barcelona y l'Hospitalet y Tarragona del Instituto de Medicina Legal y Ciencias Forenses de Cataluña durante los años 2016-2017. Los datos se obtuvieron de los registros de periciales extrajudiciales de ambas divisiones. RESULTADOS: Se realizaron 547 informes médico-forenses. Los accidentes fueron mayoritariamente causados por colisión por alcance entre turismos en trayectos urbanos. Las lesiones fueron en su mayoría de carácter leve, siendo la afectación cervical la más frecuente. En un alto porcentaje, se resolvió con tratamiento conservador en una media de 69 días, asociándose la aparición de secuelas leves en casi la mitad de los casos. El perjuicio estético se informó en el 14%. No hubo diferencias entre ambas divisiones. CONCLUSIÓN: Las periciales extrajudiciales resultan una fuente de información valiosa para la valoración de los perjuicios causados a las víctimas de accidentes de circulación. Como en otros estudios, la mayoría de lesiones son de carácter leve y se asocian a colisiones entre turismos, causando secuelas en la mitad de los casos. Parece que la vía extrajudicial es eficaz en las reclamaciones por accidentes de circulación, pero son necesarios más estudios para obtener una visión más completa

INTRODUCTION: Since the application of Law 35/2015, the Legal and Forensic Medicine Institutes provide extrajudicial expert advice at the request of individuals for the resolution of traffic accident claims. The objective is to analyze the most relevant medical-legal aspects of this expert advice. MATERIAL AND METHOD: This is a retrospective descriptive study of the extrajudicial expert advice in the divisions of Barcelona and l'Hospitalet, and Tarragona of the Catalonian Legal and Forensic Medicine Institute from 2016-2017. The data was obtained from the extrajudicial expert records of both divisions. RESULTS: 547 medical-forensic reports were made. The accidents were mainly caused by a rear collision between cars on urban routes. The injuries were mostly minor, with cervical involvement being the most frequent. A high percentage were resolved with conservative treatment in an average of 69 days, there were mild sequelae in almost half of the cases. Aesthetic damage was reported in 14%. There were no differences between the two divisions. CONCLUSION: Extrajudicial expert advice is a valuable source of information for assessing the damage caused to traffic accident victims. As in other studies, most injuries are mild and are associated with collisions between cars, causing sequelae in half of the cases. It seems that the extrajudicial route is effective in helping resolve traffic accident claims, but more studies are needed to obtain a more complete vision

Distracted Driving Laws and Motor Vehicle Crash Fatalities.

BACKGROUND: Motor vehicle crashes (MVCs) continue to be the leading cause of death in youth 16 to 24 years old in the United States. Distracted driving has been shown to increase the risk of MVCs in all drivers, particularly teenagers. We aimed to determine the association between fatal MVC rates involving 16- to 19-year-old drivers and state distracted driving laws. METHODS: We conducted a retrospective time series analysis of fatal MVCs in the United States involving drivers and passengers 16 to 19 years old from 2007 to 2017 using the Fatality Analysis Reporting System. Multivariable negative binomial regression analysis was performed to compare MVC rates across states on the basis of different types and strengths of distracted driving laws. RESULTS: There were 38 215 drivers 16 to 19 years old involved in fatal MVCs from 2007 to 2017. Incidence of fatal MVCs was highest for 19-year-old drivers (27.2 out of 100 000 19-year-old persons) and lowest for 16-year-olds (10.7 out of 100 000). States with primarily enforced texting bans had lower MVC fatality rates overall involving 16- to 19-year-old drivers (adjusted incidence rate ratio: 0.71; 95% confidence interval: 0.67-0.76). Texting bans and handheld bans for all drivers were associated with decreased MVC fatalities in all age groups. CONCLUSIONS: In the United States, primarily enforced distracted driving laws are associated with a lower incidence of fatal MVCs involving 16- to 19-year-old drivers. Bans on all handheld device use and texting bans for all drivers are associated with the greatest decrease in fatal MVCs. Adoption of universal handheld cellphone bans in all states may reduce the incidence of distracted driving and decrease MVC fatalities.

Epidemiology and Pattern of Traumatic Brain Injuries at Annapurna Neurological Institute & Allied Sciences, Kathmandu, Nepal.

BACKGROUND: Traumatic brain injury (TBI) constitutes a major health and socioeconomic problem worldwide. It represents the greatest contribution to death and disability among all trauma-related injuries globally. TBIs are a leading cause of death and disability in Nepal, despite improvements in safety regulations and implementation of strict drunk driving laws. We describe the epidemiology of patients with TBI following admission to our hospital. We discuss the implementation of specific strategies to reduce its incidence. METHODS: We conducted a retrospective cross-sectional study of patients presenting to Annapurna Neurological Institute & Allied Sciences (ANIAS), Kathmandu, with a TBI between September 2018 to September 2019. RESULTS: One-hundred and sixty-seven patients presented with a TBI. The most common age groups were younger than 15 years old and 15-25 years old, and the majority were male (73%). The commonest cause of TBI was road traffic accidents (RTA) (59%). Drivers riding motorcycles were the predominant mechanism of RTA (38%). Helmet use was seen in 57% of patients riding 2-wheelers. Alcohol consumption was reported in 22% of all patients. Skull fractures were the most common diagnosis. Most patients were managed conservatively (84%). CONCLUSIONS: TBI should be recognized as an important public health problem in Nepal. TBI is responsible for a considerable number of neurosurgical admissions to ANIAS. Our study showed patients most vulnerable to TBI are males younger than 25 years old. The implementation of stricter traffic rules and regulations, helmet law enforcement, and public education programs may be helpful in decreasing the number of TBI.

Trends in lawyer use in road traffic injury compensation claims.

Injury compensation claimants use legal services to help them navigate compensation schemes, including accessing benefits and resolving disputes. Little is known, however, about the extent of lawyer use by compensation claimants, including changes over time. This paper presents findings from one of the largest empirical investigations of lawyer use in an injury compensation setting to date. Using evidence from more than 275,000 claims in the road traffic injury scheme in the state of Victoria, Australia, this study examines the prevalence of, and changes in, lawyer use between 2000 and 2015. The analysis identifies a significant increase in the use of lawyers in the scheme, and explores possible explanations. This study provides critical insights into lawyer use in compensation settings: the steep increase in lawyer involvement has both access to justice and financial implications for compensation schemes, given the associations between lawyer use, claimant outcomes, and long-term scheme viability.

A medicolegal approach to the very rare Auto-Brewery (endogenous alcohol fermentation) syndrome.

Objective: Auto-Brewery Syndrome is defined as the production of ethanol by microorganisms becoming dominant when inhabiting the gastrointestinal system or through the impairment of flora because of carbohydrate-rich nutrition, and the elevation of levels of measured ethanol. This study aimed to consider medicolegal approaches to individuals with Auto-Brewery Syndrome.Methods: A 38-year-old male patient who was involved in a traffic accident about two months ago and whose driving license was taken away due to his blood alcohol level measuring above the legal limits was referred to our department for the detection of any condition which might cause the elevation of blood alcohol levels without alcohol intake, in consequence of his objection submitted to the judicial authorities claiming that he had not drunk alcohol on the day of the event.Results: After the informed consent of the individual was obtained, he was admitted under supervision to an inpatient unit with a visitor ban in a manner which inhibited his intake of alcohol, and during admission his blood alcohol levels were measured at intervals. His blood alcohol level was measured as 160 mg/dl at the time of admission for monitoring and as 141 mg/dl, 322 mg/dl, 208 mg/dl and 279 mg/dl after two hours, six hours, 12 hours and 20 hours, respectively. His liver function test results were high and neurological examination was normal. The individual was diagnosed with Auto-Brewery Syndrome.Conclusion: Various gastrointestinal system abnormalities such as through laparotomy, gastrectomy are reported in most of Auto-Brewery syndrome cases. There are cases, although rare, where gastrointestinal disorders are not detected and secondary disorders of normal intestinal flora due to frequent antibiotic use seem to be a factor. Such a condition is present in the current case. Those who are aware of this condition may falsely rely on it as a method to avoid penalties. On the other hand, genuine patients suffering from this condition may be caught by traffic control and become victims of the condition. For that reason, a meticulous and planned approach should be taken to verify the condition and to ensure that it is not overlooked.

State or market? How to effectively decrease alcohol-related crash fatalities and injuries.

BACKGROUND: It is estimated that more than 270 000 people die yearly in alcohol-related crashes globally. To tackle this burden, government interventions, such as laws which restrict blood alcohol concentration (BAC) levels and increase penalties for drunk drivers, have been implemented. The introduction of private-sector measures, such as ridesharing, is regarded as alternatives to reduce drunk driving and related sequelae. However, it is unclear whether state and private efforts complement each other to reduce this public health challenge. METHODS: We conducted interrupted time-series analyses using weekly alcohol-related traffic fatalities and injuries per 1 000 000 population in three urban conglomerates (Santiago, Valparaíso and Concepción) in Chile for the period 2010-2017. We selected cities in which two state interventions-the 'zero tolerance law' (ZTL), which decreased BAC, and the 'Emilia law' (EL), which increased penalties for drunk drivers-were implemented to decrease alcohol-related crashes, and where Uber ridesharing was launched. RESULTS: In Santiago, the ZTL was associated with a 29.1% decrease (95% CI 1.2 to 70.2), the EL with a 41.0% decrease (95% CI 5.5 to 93.2) and Uber with a non-significant 28.0% decrease (95% CI -6.4 to 78.5) in the level of weekly alcohol-related traffic fatalities and injuries per 1 000 000 population series. In Concepción, the EL was associated with a 28.9% reduction (95% CI 4.3 to 62.7) in the level of the same outcome. In Valparaíso, the ZTL had a -0.01 decrease (95% CI -0.02 to -0.00) in the trend of weekly alcohol-related crashes per 1 000 000 population series. CONCLUSION: In Chile, concomitant decreases of alcohol-related crashes were observed after two state interventions were implemented but not with the introduction of Uber. Relationships between public policy interventions, ridesharing and motor vehicle alcohol-related crashes differ between cities and over time, which might reflect differences in specific local characteristics.

Missed opportunities to advance knowledge on traffic safety: Accessibility of driver licensing and crash data for scientific research.

OBJECTIVE: Identifiable individual-level driver licensing and motor vehicle crash data are essential to advancing transportation safety research. However, epidemiologic studies using such data are rare, which may reflect their inaccessibility. We conducted a legal mapping study to evaluate US state laws regulating access to driver licensing and motor vehicle crash data for use in scientific research. METHODS: Legal statutes regulating the release of driver licensing and motor vehicle crash data for all 50 US states and the District of Columbia (D.C.) were retrieved. Legal text was evaluated to determine whether these jurisdictions authorize release of identifiable individual-level licensing and crash data for use in non-governmental research. RESULTS: Thirty-six states and D.C. explicitly authorize release of identifiable individual-level licensing data to researchers. Only five states and D.C. authorize release of identifiable individual-level crash records. No states explicitly prohibit the release of individual-level data about licensing records and only three states prohibit release of individual-level crash record data, meaning that in many states it is ambiguous whether and when releasing such data to researchers is permitted. CONCLUSIONS: It is important to understand why licensing data are not used more frequently in transportation safety research given that many state laws permit access for non-governmental researchers. Reforming state laws to clarify and increase access to identifiable individual-level crash report data is an important priority for transportation safety advocates and researchers.

Existing Laws to Combat Road Traffic Injury in Nepal and Bangladesh: A Review on Cross Country Perspective.

BACKGROUND: Road traffic accidents is a leading cause of injury and death globally. The consequences of road traffic accidents are prominent in developing countries that can least afford to meet the health services, economic and societal challenges. Nepal and Bangladesh are two developing country of South Asia who bear a large share of burden due to road traffic injuries. METHODS: A non-systematic review of relevant documents using Google scholar and PubMed as well as review of relevant legal documents was done. RESULTS: Nepal and Bangladesh have traffic laws including all the key risk factors as recommended by the World Health Organization except the child restraint systems laws. The existing laws for both countries include speed, drunk driving, use of seatbelts and motorcycle helmet, driver license, vehicle condition, overloading and accident related compensations.In both the countries for post-crash response, national emergency care access number has partial coverage and in Nepal there are some provisions related to trauma registry.Vulnerable groups are pedestrians with majority of male and higher mortality found in rural areas than urban areas for both the countries. CONCLUSIONS: Both the countries have traffic laws that focus on the prevention of road traffic accidents and protection of victims. However, amendments in the existing laws are required for confronting immediate challenges of increasing accidents and injuries that both the countries face every year.

Excessive daytime sleepiness in obstructive sleep apnea: implications for driving licenses.

PURPOSE: Excessive daytime sleepiness (EDS) while driving is a major international public health issue resulting in a more than doubled risk of motor vehicle accidents (MVAs). Obstructive sleep apnea (OSA) is the most frequent medical cause of EDS. Therefore, the European Union Directive 2014/85/EU determined that "untreated moderate to severe OSA coincident with EDS constitutes a medical disorder leading to unfitness to drive." The paper aims are to provide a brief review of sleepiness and its implications for driving safety, as well as to describe the subjective and objective methods to accurately evaluate EDS in order to assess fitness to drive in patients with OSA. METHODS: We examined databases including PubMed, Medline, and EMBASE using the search terms "sleepiness at the wheel, excessive daytime sleepiness, sleepiness measure, sleep-wake cycle, obstructive sleep apnea, driving license, fitness to drive." RESULTS: Significant interindividual variability in EDS exists in patients with comparable severity of OSA. Objective methods of measuring EDS are too expensive and time consuming to be suitable for the certification of driving licenses. The reliability of subjective methods depends upon the clinical setting and subjective tools assess only limited aspects of EDS. Objective measures, such as biochemical biomarkers, must, therefore, support subjective methods. CONCLUSIONS: Extensive data have supported different subjective and objective methods for the appraisal of EDS in patients with OSA depending upon the clinical and experimental setting. Challenges remain to determine an appropriate tool for the evaluation of fitness to drive.

Using street imagery and crowdsourcing internet marketplaces to measure motorcycle helmet use in Bangkok, Thailand.

INTRODUCTION: The majority of Thailand's road traffic deaths occur on motorised two-wheeled or three-wheeled vehicles. Accurately measuring helmet use is important for the evaluation of new legislation and enforcement. Current methods for estimating helmet use involve roadside observation or surveillance of police and hospital records, both of which are time-consuming and costly. Our objective was to develop a novel method of estimating motorcycle helmet use. METHODS: Using Google Maps, 3000 intersections in Bangkok were selected at random. At each intersection, hyperlinks of four images 90° apart were extracted. These 12 000 images were processed in Amazon Mechanical Turk using crowdsourcing to identify images containing motorcycles. The remaining images were sorted manually to determine helmet use. RESULTS: After processing, 462 unique motorcycle drivers were analysed. The overall helmet wearing rate was 66.7 % (95% CI 62.6 % to 71.0 %). Taxi drivers had higher helmet use, 88.4% (95% CI 78.4% to 94.9%), compared with non-taxi drivers, 62.8% (95% CI 57.9% to 67.6%). Helmet use on non-residential roads, 85.2% (95% CI 78.1 % to 90.7%), was higher compared with residential roads, 58.5% (95% CI 52.8% to 64.1%). Using logistic regression, the odds of a taxi driver wearing a helmet compared with a non-taxi driver was significantly increased 1.490 (p<0.01). The odds of helmet use on non-residential roads as compared with residential roads was also increased at 1.389 (p<0.01). CONCLUSION: This novel method of estimating helmet use has produced results similar to traditional methods. Applying this technology can reduce time and monetary costs and could be used anywhere street imagery is used. Future directions include automating this process through machine learning.