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1.
Accid Anal Prev ; 165: 106517, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34896907

RESUMO

Despite the countless benefits derived from motorcycle usage, it has become a significant public health concern, particularly in developing countries, due to the plateauing number of fatal/serious injuries associated with them. Although it has been well documented that the frequency and fatality rates of intersection-related motorcycle crashes are high, little research efforts have been made to explore the contributory factors influencing motorcycle-involved crashes at these locations. Interestingly, no study has investigated the latent patterns and chains of factors that simultaneously contribute to the injury severity sustained by motorcycle crash casualties at intersections under different traffic control conditions in developing countries. Since motorcycles are mostly used as taxis in developing countries, it is imperative to consider the injury severity sustained by all crash casualties in the motorcycle safety analysis. This study bridges the research gap by employing a plausible data mining tool to explore hidden rules associated with motorcycle crash casualty injury severity outcomes at both signalized and non-signalized intersections in Ghana's most densely populated region, Accra, using three-year crash data spanning 2016-2018. Besides, a binary logit regression model was also employed to explore the impact of crash factors on casualty severity outcomes using the same dataset. The results from both analysis techniques were consistent; however, the data mining technique provided chains of factors which provided additional insights into the groups of factors that collectively influence the casualty injury severity outcomes. From the rule discovery results, while full license status, daytime/daylight, and shoulder presence increased the risk of fatal injuries at signalized intersections, factors such as inattentiveness, good road surface, nighttime, shoulder absence, and young rider were highly likely to increase casualty fatalities at non-signalized intersections. By controlling all or some of these risk factors, the level of injury severity on the roadways could be reduced. Based on the findings, we provide enforcement, education, and engineering-based recommendations to help improve motorcycle safety.


Assuntos
Motocicletas , Ferimentos e Lesões , Acidentes de Trânsito , Mineração de Dados , Gana/epidemiologia , Humanos , Modelos Logísticos , Ferimentos e Lesões/epidemiologia
2.
Accid Anal Prev ; 165: 106533, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34902624

RESUMO

The existing literature in road safety revealed that the relationship between motorcycle deaths and per-head income follows a Kuznets or reverse U-curve pattern, whereby motorcycle deaths incline at lower income levels but decline once the per-head income has exceeded a threshold level. The same reverse U-curve relationship was also observed between per-head income and other road injury-related variables, including road deaths, road injuries, as well as road deaths to road injuries ratio. Evidence showed that motorcycles and passenger cars are the dominant vehicle modes and contributed significantly to global road deaths. The main objective of this study is to examine the relationship between the motorcycle deaths to passenger car deaths (MDC) ratio and per-head Gross Domestic Product (GDP). Examining the relationship between the MDC ratio and GDP per capita can be effective in understanding the relative change between motorcycle and passenger car deaths at different economic development stages, as well as identifying appropriate preventive measures. We apply a panel linear regression analysis on a panel of 38 countries over the period 1965-2013. Result demonstrated that there is a reverse U-curve relationship between the MDC ratio and the logarithm of GDP per capita. This implies that, at lower levels of GDP per capita, motorcycle deaths were more prevalent than passenger car deaths, whereas as the level of GDP per capita rises, passenger car deaths became relatively prevalent than motorcycle deaths. Moreover, there is a reverse U-shaped relationship between motorcycle ownership to passenger car ownership ratio (MPC) and the MDC ratio, while a U-shaped relationship exists between relative growth in higher mobility roads as compared to higher accessibility roads (MPA) and the MDC ratio. Based on our results, policies and interventions to reduce motorcycle and passenger car deaths were suggested in the conclusion of the paper.


Assuntos
Automóveis , Motocicletas , Acidentes de Trânsito , Análise de Dados , Desenvolvimento Econômico
3.
Accid Anal Prev ; 165: 106519, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34902626

RESUMO

Response time (RT) measures in crash reconstruction are inherently constrained by the need to define a start point (onset). In straight-forward situations where the hazard appears abruptly from behind an obstruction (abrupt onset), hazard onset is typically defined as when the hazard is first visible to the motorist. In contrast, in scenarios where there is no clearly defined point of entry (gradual onset), and the potential hazard gradually transitions to an immediate hazard, the onset point is more ambiguous. In this study, a reasonable hazard onset was proposed for measuring RTs of motorcycle riders to gradual-onset hazards, following which the RTs to abrupt- and gradual-onset hazards were determined and compared. A study on motorcycle rider RTs was conducted in Singapore in which a sample of young male adults (licensed riders with more than one year's effective riding experience, and unlicensed subjects) were equipped with eye tracking glasses and were presented with two pairs of abrupt-/ gradual-onset hazard scenarios on a simple motorcycle simulator. Their RTs were recorded. Initial deviation from the straight path (start of turning manoeuvre) of the intruding hazard vehicle was determined to be a more appropriate onset (start point when measuring RTs) for gradual-onset hazards when compared with referencing the onset against travel lane incursions. Participants generally took longer to respond to gradual-onset hazards than abrupt-onset hazards. Unlicensed subjects tended to underperform relative to licensed riders. The findings from this study contribute to the literature in the relatively novel field of motorcycle RTs and should be of interest to crash reconstructionists as well road safety professionals in designing road operations.


Assuntos
Acidentes de Trânsito , Motocicletas , Adulto , Humanos , Masculino , Percepção , Tempo de Reação , Singapura
4.
Accid Anal Prev ; 163: 106457, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34735886

RESUMO

The prevalence of motorcycle riding among novice riders in most Southeast Asia countries presents an alarming rate of traffic violations and fatal accidents. Since 2013, Taiwan's government has gradually required a road safety class (RSC) for the rider's licensing process. The RSC consisted of watching videotapes of motorcycle-involved crashes followed by lectures on safety measures. Our study tried to see whether a compulsory RSC could lower the likelihood and frequency of road accidents and traffic violations among novice riders. To avoid self-selection bias, we selected 480,114 novice riders aged 18-20 years, licensed one year before starting the trial period and one year after full implementation of RSC. Using the 2012-2018 data from the Taiwan Ministry of Transportation and Communication (MOTC), we applied the logistic model to evaluate RSC effects on the risk of violations and accidents. Then, we used the negative binomial regression to model their frequency in response to RSC exposure. Following the novice drivers 1-3 years after licensing, our results showed that the RSC has a short-term effect in lowering their traffic violations' likelihood by 12%∼17% and their frequency by 11%; however, the RSC effects only last two years in reducing the counts of motorcycle-involved offenses and accidents. The RSC reduction effect was lower for the tendency of accidents than the violations, probably because committing traffic violations was self-determined; in contrast, the collision occurrence was more or less related to the riders' own or other road users' carelessness. The RSC could be more effective if a certification test for road safety education were required or if a penalty is imposed on distracted learners during the training.


Assuntos
Acidentes de Trânsito , Motocicletas , Acidentes de Trânsito/prevenção & controle , Adolescente , Humanos , Modelos Logísticos , Taiwan/epidemiologia , Adulto Jovem
5.
Ann Ital Chir ; 92: 518-520, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34795113

RESUMO

We report the case of a patient who presented after a motorcycle accident a grade IV kidney lesion primarily treated with a NOM, which failed. We discuss the possibility at admission to select a subgroup of patients with a high grade (IV and V) kidney trauma in whom NOM might fail. KEY WORDS: Kidney Trauma, High grade renal trauma, Non operative management.


Assuntos
Tratamento Conservador , Ferimentos não Penetrantes , Acidentes , Humanos , Escala de Gravidade do Ferimento , Rim/lesões , Motocicletas , Estudos Retrospectivos , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/terapia
6.
BMC Public Health ; 21(1): 1954, 2021 10 28.
Artigo em Inglês | MEDLINE | ID: mdl-34711187

RESUMO

BACKGROUND: Motorcycles are one of the most commonly used transportation modes in low and middle-income countries. In India, motorized two-wheelers comprise 70% of the total vehicle population, and motorcycle users are considered the most vulnerable road users. It is essential to understand the risky riding behaviour and associated factors among the motorcyclists to develop evidence-based traffic safety programs targeting motorcycle riders. The purpose of the current study was two-fold. First, it aimed to determine the appropriate structure of a modified version of the MRBQ among young riders in Manipal, India. Second, it assessed to what extent MRBQ factors were associated with self-reported crash involvement and violations. METHODS: The motorcycle rider behaviour questionnaire (MRBQ) is a 43-item scale that assesses five aspects of risky motorcycle rider behaviour, i.e., violations, control errors, traffic errors, stunts, and protective equipment. The MRBQ, along with measures of socio-demographic variables and the number of motorcycle crashes, was filled out by 300 young motorcycle riders who were in the age group of 18-25 years and had been riding for at least the past three years (93% males, 92.3% students). RESULTS: Five factors emerged out of the MRBQ after an exploratory factor analysis: traffic errors, control errors, stunts, protective equipment, and violations. Cronbach's alpha for these factors ranged from .66 to .82. Reports of performing stunts and committing violations were positively associated with self-reported near-crash experiences over the past three months. Riders reporting stunts, violations and using a motorcycle of 125-200 cc reported having received more fines in the last three months. These findings were confirmed in both univariate and multivariate binary logistic regression models. CONCLUSION: The study assessed the factor structure of a modified version MRBQ and the extracted factors associations with self-reported crash involvement. The factor structure revealed in the current study is consistent with MRBQ factor structures found in other countries. However, the support for a relationship between MRBQ factors and self-reported crashes was less significant. The findings suggest that if replicated by future studies, local policymakers are advised to focus on the five MRBQ factors while planning future interventions to achieve a reduction in the number of road crashes among motorcyclists.


Assuntos
Acidentes de Trânsito , Motocicletas , Adolescente , Adulto , Feminino , Humanos , Índia/epidemiologia , Masculino , Assunção de Riscos , Inquéritos e Questionários , Adulto Jovem
7.
PLoS One ; 16(10): e0258796, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34665845

RESUMO

Traffic police riders are exposed to prolonged static postures causing significant angular deviation of the musculoskeletal, including the lumbar angle (L1-L5). This postural alteration contributes to awkward posture, musculoskeletal disorders and spinal injury, especially in the lower back area, as it is one of the most severe modern diseases nowadays. Thus, the study aimed to evaluate the effect of lumbar support with a built-in massager system on spinal angle profiles among traffic police riders. A randomised controlled trial (pre-testpost-test control design) was used to assess spinal angle pattern while riding the high-powered motorcycle for 20 minutes. Twenty-four traffic police riders were randomly selected to participate and 12 riders were assigned to the control group and 12 riders to the experimental group. The pre-test and post-test were conducted at a one-week interval. Each participant was required to wear a TruPosture Smart Shirt (to monitor spinal posture). The TruPosture Apps recorded the spinal angle pattern. The data indicated that the police riders using motorcycle seat with lumbar support and built-in massager system showed a huge improvement in maintaining posture which only involves slight spinal angle deviation changes from the spinal reference angle throughout the 20 minutes ride. The data collected then were analysed using the Mann-Whitney test and Wilcoxon signed-ranked test to verify a statistically significant difference between and within the control and experimental groups. There were significant differences in all sensors between the control group and experimental groups (p<0.05) and within the experimental group. According to the findings, it can be said that the ergonomic intervention prototype (lumbar support with built-in massager system) successfully helps to maintain and improve the natural curve of the spinal posture. This indirectly would reduce the risk of developing musculoskeletal disorders and spinal injury among traffic police riders.


Assuntos
Ergonomia/instrumentação , Massagem/instrumentação , Motocicletas , Postura/fisiologia , Coluna Vertebral/anatomia & histologia , Adulto , Desenho de Equipamento , Feminino , Humanos , Masculino , Aplicativos Móveis , Polícia , Coluna Vertebral/fisiologia , Tecnologia sem Fio , Adulto Jovem
8.
BMC Geriatr ; 21(1): 603, 2021 10 26.
Artigo em Inglês | MEDLINE | ID: mdl-34702189

RESUMO

BACKGROUND: South Korea has a rapidly ageing population. This study aimed to provide epidemiologic data and to identify the characteristics of the patterns and clinical outcomes of two-wheeled vehicle-related injuries (bicycle and motorcycle) in elderly riders. METHODS: This study retrospectively analyzed data from the National Emergency Department Information System from 2016 to 2018. Adult patients (≥ 20 years old) who were injured while using two-wheeled vehicles were included. Elderly patients were defined as being 65 years and older. The analysis was performed for 65,648 bicycle-related injuries (15,272 elderly patients) and 87,855 motorcycles-related injuries (17,292 elderly patients). RESULTS: In emergency departments (EDs), the average injury severity score (ISS) for motorcycle-related accidents was 9.8 ± 11.2 in the younger group and 14.1 ± 14.7 in the elderly group (p = 0.001). In addition, the average ISS of bicycle-related accidents was 7.1 ± 8.9 in the younger group and 10.5 ± 12.3 in the elderly group (p = 0.001). Two-wheeled vehicle accident mortality rates of elderly riders (0.9% for bicycle and 1.8% for motorcycle in the ED; 4.1% for bicycle and 3.8% for motorcycle in the hospital) were more than twice those of younger riders. The elderly stayed in the hospital longer than younger patients (485.2 ± 543.0 h vs 336.8 ± 385.5 h, p = 0.001) for bicycle-related injuries. They also stayed longer for motorcycle-related injuries (529 ± 598.6 h vs 452.0 ± 543.55 h, p = 0.001). The logistic regression analysis showed that age ≥ 65 years was an independent factor associated with severe trauma (ISS ≥ 16) for both bicycle-related injuries (adjusted odds ratio [OR] 2.185 [95% Confidence Interval (CI) 2.072-2.303]) and motorcycle-related injuries (adjusted OR 1.220 [95% CI 1.137-1.287]). CONCLUSION: Two-wheeled vehicle-related injuries in the elderly were associated with higher ISS, length of hospital stay, and mortality than in younger riders. Analysing the characteristics of two-wheeled vehicle-related injuries in the elderly can be the basis for planning to reduce and prevent injuries in elderly riders.


Assuntos
Motocicletas , Ferimentos e Lesões , Acidentes de Trânsito , Idoso , Ciclismo , Humanos , República da Coreia/epidemiologia , Estudos Retrospectivos , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/epidemiologia
9.
Sensors (Basel) ; 21(19)2021 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-34640946

RESUMO

Currently, the interest in creating autonomous driving vehicles and progressively more sophisticated active safety systems is growing enormously, being a prevailing importance factor for the end user when choosing between either one or another commercial vehicle model. While four-wheelers are ahead in the adoption of these systems, the development for two-wheelers is beginning to gain importance within the sector. This makes sense, since the vulnerability for the driver is much higher in these vehicles compared to traditional four-wheelers. The particular dynamics and stability that govern the behavior of single-track vehicles (STVs) make the task of designing active control systems, such as Anti-lock Braking System (ABS) systems or active or semi-active suspension systems, particularly challenging. The roll angle can achieve high values, which greatly affects the general behavior of the vehicle. Therefore, it is a magnitude of the utmost importance; however, its accurate measurement or estimation is far from trivial. This work is based on a previous paper, in which a roll angle estimator based on the Kalman filter was presented and tested on an instrumented bicycle. In this work, a further refinement of the method is proposed, and it is tested in more challenging situations using the multibody model of a motorcycle. Moreover, an extension of the method is also presented to improve the way noise is modeled within this Kalman filter.


Assuntos
Condução de Veículo , Motocicletas
10.
Artigo em Inglês | MEDLINE | ID: mdl-34501686

RESUMO

The study results serve as a reminder for parents, children, and drivers to be alert to the danger of traffic crashes on Halloween. The aim of this study was to examine whether Halloween is associated with a higher incidence of traffic injuries and whether traffic injuries sustained on Halloween are more severe than those sustained on other days. The U.K. STATS19 database, including the data of all road traffic crashes occurring from 1990 to 2017, was employed. A total of 73,587 pediatric traffic casualties (involving pedestrians, cyclists, and moped riders) were included. Between 17:00 and 19:00 (17:00~18:59) on Halloween, the number of casualties was higher than that on other public holidays and usual days. The logistic regression model revealed that, between 17:00 and 18:00 (17:00~17:59), the risk of being killed or seriously injured on Halloween was 34.2% higher (odds ratio = 1.342; 95% CI = 1.065-1.692) than that on other days. Pediatric crashes occurring on Halloween are associated with a higher number of injuries and increased injury severity.


Assuntos
Pedestres , Ferimentos e Lesões , Acidentes de Trânsito , Criança , Humanos , Motocicletas , Prevalência , Reino Unido/epidemiologia , Ferimentos e Lesões/epidemiologia
11.
Pan Afr Med J ; 39: 130, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34527146

RESUMO

Economic development in low-income countries has led to a considerable increase in motor vehicles, in particular motorcycles. Traffic accident-related fractures are therefore increasing. The treatment of long bone fractures is, in the majority of cases, based on locked intramedullary nailing, a procedure which is rarely available in countries with poor sanitary conditions. To provide optimal treatment to these countries, the SIGN (Surgical Implant Generation Network) nail was developed in 1999 by Lewis Zirkle. It is currently used free of charge in 53 countries. In return, an international database must be completed in order to assess and develop it. In the light of our experiences in Haiti and Burundi and on the basis of a literature review, we here highlight the conceptual and technical features of SIGN nail whose implant in French-speaking countries is still limited.


Assuntos
Acidentes de Trânsito , Pinos Ortopédicos , Fixação Intramedular de Fraturas/métodos , Burundi , Bases de Dados Factuais , Países em Desenvolvimento , Fixação Intramedular de Fraturas/instrumentação , Haiti , Humanos , Motocicletas
12.
Accid Anal Prev ; 162: 106396, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34547668

RESUMO

This study estimates the effect of gasoline prices on road deaths by vehicle mode using annual data for 62 countries for 2000-2018 and all states of the United States (US) for 1998-2018. Higher gasoline prices are associated with fewer overall road deaths. The proportional effect on motorcyclist deaths tends to be smaller or even have the opposite sign, especially in countries that are not highly dependent on motorcycles. For the US, a positive effect of gasoline prices on motorcyclist deaths is found, with an elasticity of about 0.3. There is also a positive relationship between gasoline prices and motorcycle registrations in the US. The results confirm that additional attention towards motorcyclist safety is warranted in times of high fuel prices.


Assuntos
Acidentes de Trânsito , Motocicletas , Gasolina , Humanos , Estados Unidos/epidemiologia
13.
PLoS Med ; 18(9): e1003795, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34534215

RESUMO

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.


Assuntos
Acidentes de Trânsito/prevenção & controle , Traumatismos Craniocerebrais/prevenção & controle , Países em Desenvolvimento/economia , Saúde Global/legislação & jurisprudência , Dispositivos de Proteção da Cabeça , Renda , Aplicação da Lei , Motocicletas/legislação & jurisprudência , Acidentes de Trânsito/legislação & jurisprudência , Acidentes de Trânsito/mortalidade , Traumatismos Craniocerebrais/etiologia , Traumatismos Craniocerebrais/mortalidade , Saúde Global/economia , Humanos , Formulação de Políticas , Fatores de Proteção , Medição de Risco , Fatores de Risco
14.
PLoS One ; 16(9): e0256620, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34473731

RESUMO

Pretimed signalized intersection is known as a common source of congestion, especially in urban heterogeneous traffic. Furthermore, the accuracy of saturation flow rate is found to cause efficient and vital capacity estimation, in order to ensure optimal design and operation of the signal timings. Presently, the traffic also consists of diverse vehicle presence, each with its own static and dynamic characteristics. The passenger car equivalent (PCE) in an essential unit is also used to measure heterogenous traffic into the PCU (Passenger Car Unit). Based on the collection of observed data at three targets in Banda Aceh City, this study aims to redetermine the PCEs by using Bayesian linear regression, through the Random-walk Metropolis-Hastings and Gibbs sampling. The result showed that the obtained PCE values were 0.24, 1.0, and 0.80 for motorcycle (MC), passenger car (PC), and motorized rickshaw (MR), respectively. It also showed that a significant deviation was found between new and IHCM PCEs, as the source of error was partially due to the vehicle compositions. The present traffic characteristics were also substantially different from the prevailing conditions of IHCM 1997. Therefore, the proposed PCEs enhanced the accuracy of base saturation flow prediction, provided support for traffic operation design, alleviated congestion, and reduced delay within the city, which in turn improved the estimation of signalized intersection capacity.


Assuntos
Automóveis/estatística & dados numéricos , Modelos Estatísticos , Motocicletas/estatística & dados numéricos , Condução de Veículo , Teorema de Bayes , Cidades , Simulação por Computador , Humanos , Indonésia
15.
N Z Med J ; 134(1540): 16-24, 2021 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-34482385

RESUMO

INTRODUCTION: Liver injuries sustained in blunt and penetrating abdominal trauma may cause serious patient morbidity and even mortality. AIM: To review the recent experience of liver trauma at Auckland City Hospital, describing the mechanism of injury, patient management, outcomes and complications. METHODS: A retrospective cohort study was performed, including all patients admitted to Auckland City Hospital with liver trauma identified from the trauma registry. Patient clinical records and radiology were systematically examined. RESULTS: Between 2006-2020, 450 patients were admitted with liver trauma, of whom 92 patients (20%) were transferred from other hospitals. Blunt injury mechanisms, most commonly motor-vehicle crashes, predominated (87%). Stabbings were the most common penetrating mechanism. Over half of liver injuries were low risk American Association for the Surgery of Trauma (AAST) grade I and II (56%), whereas 20% were severe grade IV and V. Non-operative management was undertaken in 72% of patients with blunt liver trauma and 92% of patients with penetrating liver trauma underwent surgery. Liver complications occurred in 11% of patients, most commonly bile leaks (7%), followed by delayed haemorrhage (2%). Thirty-two patients died (7%), with co-existing severe traumatic brain injury as the leading cause of death. There was a significant reduction in death from haemorrhage in patients with grade IV and V liver trauma between the first and second half of the study period (p=0.0091). CONCLUSION: Although the incidence and severity of liver trauma at Auckland City Hospital remained stable, there was a reduction in mortality, particularly death as a result of haemorrhage.


Assuntos
Traumatismos Abdominais/epidemiologia , Lesões por Esmagamento/epidemiologia , Fígado/lesões , Mortalidade/tendências , Ferimentos não Penetrantes/epidemiologia , Ferimentos Perfurantes/epidemiologia , Traumatismos Abdominais/mortalidade , Traumatismos Abdominais/terapia , Acidentes por Quedas , Acidentes de Trânsito , Falso Aneurisma/epidemiologia , Sistema Biliar/lesões , Lesões Encefálicas Traumáticas/mortalidade , Causas de Morte , Lesões por Esmagamento/mortalidade , Lesões por Esmagamento/terapia , Embolização Terapêutica , Hemobilia/epidemiologia , Hemorragia/mortalidade , Artéria Hepática , Humanos , Laparoscopia , Laparotomia , Motocicletas , Necrose , Nova Zelândia/epidemiologia , Pedestres , Ferimentos não Penetrantes/mortalidade , Ferimentos não Penetrantes/terapia , Ferimentos Perfurantes/mortalidade , Ferimentos Perfurantes/terapia
16.
BMJ Open ; 11(9): e044394, 2021 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-34489264

RESUMO

INTRODUCTION: Diabetes is common (about 20 million patients in Europe) and patients with diabetes have more surgical interventions than the general population. There are plausible pathophysiological and clinical mechanisms suggesting that patients with diabetes are at an increased risk of postoperative complications. When postoperative complications occur in the general population, they increase major adverse events and subsequently increase 1-year mortality. This is likely to be worse in patients with diabetes. There is variation in practice guidelines in different countries in the perioperative management of patients with diabetes undergoing major surgery and whether this may affect postoperative outcome has not been investigated on a large scale. Neither is it known whether different strata of preoperative glycaemic control affects outcome. METHODS AND ANALYSIS: A prospective, observational, international, multicentre cohort study, recruiting 5000 patients with diabetes undergoing elective or emergency surgery in at least n=50 centres. Inclusion criteria are any patient with diabetes undergoing surgery under any substantive anaesthetic technique. Exclusion criteria are not being a confirmed diabetic patient and patients with diabetes undergoing procedures under monitored sedation or local anaesthetic infiltration only. Follow-up duration is 30 days after surgery. Primary outcome is days at home at 30 days. Secondary outcomes are Comprehensive Complications Index, Quality of Recovery (QoR-15) score on Day 1 postoperatively, 30-day mortality, length of hospital stay and incidence of specific major adverse events (Myocardial Infarction (MI), Myocardial Injury after Non-cardiac Surgery (MINS), Acute Kidney Injury (AKI), Postoperative Pulmonary Complications (PPC), Cerebrovascular Accident (CVA), Pulmonary Embolism (PE), DVT, surgical site infection, postoperative pulmonary infection). Tertiary outcomes include time to resumption of normal diabetes therapy, incidence of diabetic ketoacidosis or hypoglycaemia, incidence and duration of use of intravenous insulin infusion therapy and change in diabetic management at 30 days. ETHICS AND DISSEMINATION: This study will adhere to the principles of the Declaration of Helsinki (amendment 2013) by the World Medical Association and the ICH-Good Clinical Practice (GCP) Guidelines E6(R2). Specific national and local regulatory authority requirements will be followed as applicable. Ethical approval has been granted by the Institutional Review Board of the Mater Misericordiae University Hospital, Dublin, Ireland (Reference: 1/378/2167). As enrolment for this study is ongoing, ethical approval from additional centres is being added continuously. The main results of Management and Outcomes of Perioperative Care among European Diabetic Patients and its substudies will be published in peer-reviewed international medical journals and presented at Euroanaesthesia congress and other international and national meetings. TRIAL REGISTRATION NUMBER: NCT04511312.


Assuntos
Diabetes Mellitus , Motocicletas , Anestesia Local , Estudos de Coortes , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/epidemiologia , Humanos , Assistência Perioperatória , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos
17.
Artigo em Inglês | MEDLINE | ID: mdl-34574746

RESUMO

Road traffic injury (RTI) is a leading cause of death in developing countries. This burden affects not only locals, but also international travelers. Data on international travelers with RTIs in Thailand, especially from a medical perspective, are limited. This study aimed to analyze the factors associated with severe health outcomes following RTIs among international travelers at a university hospital emergency center in Thailand from January 2015 to December 2019. The retrieved data consisted of demographics, risks, preventive factors, and health outcomes. The severity of outcome was classified as fatality, hospitalization, or non-severe. A multinomial logistic regression model was used to identify the possible determinants of severity of health outcome among international travelers with RTI. A total of 720 travelers with RTIs (69% males; 82.5% were Southeast Asian) were included, with a mean age of 28.5 years. Of these, 144 (20%) had severe health outcomes: 64 (9%) fatalities and 80 (11%) hospitalizations. The level of severity of outcome was not associated with travelers' demographics, but was associated with conventional risk factors, i.e., motorcycle use, alcohol/drug use, night-time driving, and less use of seatbelt/helmet. In a multinomial logistic regression analysis, alcohol drinking (adjusted odds ratio (AOR) 2.53, 95% confidence interval (CI) 1.41-4.55) and night-time driving (AOR 2.54, 95% CI 1.36-4.75) were associated with hospitalization. Patients who had a history of tetanus vaccination were less likely to die (AOR 0.37, 95% CI 0.17-0.81). In conclusion, one-fifth of RTIs resulted in severe health outcomes, and 9% were fatal. Road safety campaigns in Thailand should target travelers of all nationalities. Interventions that enhance travelers' safety practices and proper preparation for road accidents should be explored further.


Assuntos
Acidentes de Trânsito , Ferimentos e Lesões , Adulto , Feminino , Hospitais Universitários , Humanos , Masculino , Motocicletas , Estudos Retrospectivos , Tailândia/epidemiologia , Ferimentos e Lesões/epidemiologia
18.
Artigo em Inglês | MEDLINE | ID: mdl-34360030

RESUMO

This case study was conducted to assess muscle pattern, as measured by surface electromyography (sEMG), and its changes during a controlled superbike closed-road track training session. The sEMG signals were recorded unilaterally from biceps brachii (BB), triceps brachii (TB), anterior and posterior part of the deltoid (DA and DP respectively), flexor digitorum superficialis (FS), extensor carpi radialis (CR), extensor digitorum communis (ED) and pectoralis major (PM) during three rounds of 30 min. sEMG signals selected for analysis came from the beginning of the braking action to the way-out of the curves of interest. Considering the laps and rounds as a whole and focusing on the forearm muscles, ED was more systematically (84%) assigned to a state of fatigue than FS (44%) and CR (39%). On the opposite, the TB and DP muscles showed a predominant state of force increase (72%). Whereas the BB showed alternatively a state of fatigue or force increase depending on the side of the curve, when taking into account only the sharpest curves, it showed a predominant state of force increase. In conclusion, the fact that forearm muscles must endure a long-lasting maintenance of considerable activity levels explains why they easily got into a state of fatigue. Moreover, TB and DA are particularly relevant when cornering.


Assuntos
Motocicletas , Fadiga Muscular , Eletromiografia , Antebraço , Humanos , Músculo Esquelético
19.
Artigo em Inglês | MEDLINE | ID: mdl-34360219

RESUMO

Despite a reduction in the maximal voluntary isometric contraction (MVCisom) observed systematically in intermittent fatigue protocols (IFP), decrements of the median frequency, assessed by surface electromyography (sEMG), has not been consistently verified. This study aimed to determine whether recovery periods of 60 s were too long to induce a reduction in the normalized median frequency (MFEMG) of the flexor digitorum superficialis and carpi radialis muscles. Twenty-one road racing motorcycle riders performed an IFP that simulated the posture and braking gesture on a motorcycle. The MVCisom was reduced by 53% (p < 0.001). A positive and significant relationship (p < 0.005) was found between MFEMG and duration of the fatiguing task when 5 s contractions at 30% MVCisom were interspersed by 5 s recovery in both muscles. In contrast, no relationship was found (p > 0.133) when 10 s contractions at 50% MVC were interspersed by 1 min recovery. Comparative analysis of variance (ANOVA) confirmed a decrement of MFEMG in the IFP at 30% MVCisom including short recovery periods with a duty cycle of 100% (5 s/5 s = 1), whereas no differences were observed in the IFP at 50% MVCisom and longer recovery periods, with a duty cycle of 16%. These findings show that recovery periods during IFP are more relevant than the intensity of MVCisom. Thus, we recommend the use of short recovery periods between 5 and 10 s after submaximal muscle contractions for specific forearm muscle training and testing purposes in motorcycle riders.


Assuntos
Antebraço , Fadiga Muscular , Eletromiografia , Gestos , Força da Mão , Humanos , Teste de Materiais , Motocicletas , Músculo Esquelético
20.
Accid Anal Prev ; 160: 106312, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34339913

RESUMO

Powered two-wheelers (PTW) constitute the most vulnerable type of road user, primarily due to their lack of protection compared to other motorized vehicles, which can lead to a severe accident in the event of crashes. A notable increase in the percentage of PTW accidents resulting in fatalities has raised a serious need for further research in understanding riding behavior. The Motorcycle rider behavior questionnaire (MRBQ) based studies have shown promising results by using MRBQ to relate riding behavior with crash risk. Despite numerous studies using the MRBQ technique and inconsistency in derived inferences across the studies highlighted the need to revise MRBQ and carry out predictive validity for capturing the correct riding behavior of Indian riders. Therefore, this research modified the previously available questionnaire by considering the focus group's opinion, consisting of twenty professional riders, two transportation experts, and two traffic police officers. Additionally, the predictive validity check of MRBQ was carried out using a sample of Indian riders consisting of 392 participants. The exploratory factor analysis of the MRBQ revealed a 32 item version of the questionnaire divided into a four-factor structure (traffic errors, control errors, speed violations, and stunts). The present research highlighted some critical dissimilarities between PTW riders of India and other countries. The low mean score (based on the Likert scale) of the items under the four-factor structure indicated overall a safe PTW rider behavior of Indian riders. Among the four factors, speed violation showed the highest mean score and stunts showed the least mean score indicating frequent and infrequent aberrant ridding behaviors, respectively. A known group construct validity check revealed that gender had a significant and age an insignificant effect on the reporting of aberrant riding behaviors. Furthermore, a negative binomial regression analysis revealed that traffic error had the highest incidence rate ratio, confirming it to be the most significant predictor of crash risk for Indian riders. Finally, the study briefly discussed counter-measure strategies targeting specific riding behavior.


Assuntos
Acidentes de Trânsito , Motocicletas , Humanos , Índia/epidemiologia , Assunção de Riscos , Inquéritos e Questionários
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