Public health consequences of road traffic injuries – Estimation of seriously injured persons based on risk for permanent medical impairment

Despite the fact, that Sweden has one of the safest traffic environments in the world, a large number of people are still injured in road traffic accidents in Sweden. The core concept of the Vision Zero that was adopted by the Swedish parliament in 1997 is to decrease the number of deaths and serious injuries caused by traffic. The vision has been followed-up in terms of decreased mortality, but there was not a consensus on how the concept “seriously injured” should be measured at that time. The aim of this paper is to describe how to develop a measure to estimate the number of seriously injured people in Sweden. The results show that it is possible to estimate the health impact of road traffic accidents based on the definition of medical impairment. According to the results, 8389 people were seriously injured (permanently medical impaired more then 1%) in the road transport area in Sweden in 2013. If the number of people who had slipped or fallen down without any vehicle being involved is excluded, the number of seriously injured was around 4700. The result of the study has been included in the road safety goal for Sweden with the aim to have 25% less seriously injured people in 2020 than the average for the years 2006–2008. The results also showed that 91% of the seriously injured were transported by car, bike or by foot. The relatively high proportion of pedestrian fall accidents happening within the transport system irrespective of whether a vehicle was moving or not raises the question whether these types of accidents should be included in the reporting of formal road traffic accidents.     

TEACHING HOME SAFETY AND SURVIVAL SKILLS TO LATCH-KEY CHILDREN: A COMPARISON OF TWO MANUALS AND METHODS

I evaluated the influence of two training manuals on latch-key children's acquisition of home safety and survival skills. The widely used, discussion-oriented “Prepared for Today” manual was compared with a behaviorally oriented “Safe at Home” manual. Data were scored by response criteria developed by experts and by parents' and experts' ratings of children's spontaneous answers. With both methods of scoring, three behaviorally trained children demonstrated clear and abrupt increases in skill following training in each of seven trained modules, and these increases largely persisted in real world generalization probes and at 5-month follow-up. Smaller and less stable increases in skill were found in the three discussion-trained children across the seven modules; lower skill levels were also seen in real world generalization probes and at follow-up. Neither group of children demonstrated skill increases in home safety areas that were not explicitly trained. Both training methods produced small decreases in children's self-report of general anxiety and anxiety concerning home safety. Results are discussed in terms of their implications for cost-effective training of latch-key children.     

论医疗事故的法律责任

随着我国医疗卫生体制的改革、法制建设的发展,特别是新《刑法》的施行、《执业医师法》的颁布,关于医疗事故中医方行政、民事和刑事法律责任的法律规定正逐步健全。为了引起医方的高度重视、提高医疗质量、减少医疗事故的发生、有效地避免触犯法律,故对医疗事故概念的界定、构成、免责情形及三种具体法律责任作了较为系统的阐述。     

PTSD and Emotional Distress Symptoms Measured After a Motor Vehicle Accident: Relationships with Pain Coping Profiles

This study explored differences among pain patients classified as Dysfunctional, Interpersonally Distressed, and Adaptive Copers on the Multidimensional Pain Inventory with respect to PTSD symptomatology, anxiety, and depression. Eighty-five patients with pain complaints who had experienced a serious motor vehicle accident were classified into these three pain coping categories and assessed using clinician and self-report measures. Results indicated that patients classified as Adaptive Copers (n = 24) showed less PTSD symptomatology, anxiety, and depressed mood, relative to individuals classified as Dysfunctional (n = 36) and as Interpersonally Distressed (n = 25), who did not differ on these dimensions. Emotional responses during the accident (fear, helplessness, danger, perceived control, and certainty that one would die) did not differentiate the groups. Pain profiles contributed to the prediction of self-reported PTSD symptoms, controlling for state anxiety. These data suggest that pain patients with both Dysfunctional and Interpersonally Distressed coping profiles are at elevated risk for a range of posttrauma problems following a serious motor vehicle accident.     

Predictors of post-traumatic stress symptoms following occupational accidents: A longitudinal study

Objective: Occupational accidents are highly stressful events that frequently occur and impact both the physical and mental health of workers. The aim of this study was to longitudinally assess a predictive model of posttraumatic stress symptoms (PTSS) in workers who have suffered a recent accident. Method: Two hundred and forty-four workers (77.8% men), aged 18 to 73 years, who had experienced an accident during the last month that resulted in hospitalization and/or ten or more days of sick leave, were surveyed. A second survey was carried out six months later. Regression analyses included psychological predictors (i.e. subjective severity of event, brooding and positive and negative religious coping), along with objective predictors (i.e. hospitalization, sick leave days and unemployment). Results: It was found that the main predictors of PTSS were brooding, negative religious coping, days of sick leave and unemployment, with a large effect size (R²?=?.45). Conclusions: The discussion is based on the usefulness of including selected psychological and objective predictors for detecting people more susceptible to developing psychopathology due to the stress following an accident. Identifying at-risk people for developing PTSS after an accident may help to introduce selective preventive strategies or early interventions in this population.     

The analysis of drivers’ hazard detecting ability using Empathizing–Systemizing model

Since there are drivers who repeatedly have accidents, this research postulated that the lack of hazard perception which is a primary cause of accidents might be determined by individual differences in cognitive traits. The Empathizing–Systemizing (E–S) model was used for the cognitive traits, with Empathizing expected to correspond to ability at hazard perception and fewer accidents and/or incidents (near-accidents). On the other hand, Systemizing was not expected to contribute to them. A web questionnaire was conducted to collect data of accidents and incidents experienced during ordinary driving, and this was analyzed. The results showed that drivers with higher Empathy Quotient (EQ) experienced fewer accidents and incidents. The Systemizing Quotient (SQ) had no significant effect on these experiences. However, the experience of incidents by drivers with high Systemizing Quotient increased when their Empathy Quotient was low. Based on these results, it was suggested that drivers who have a stronger Empathizing function may have a stronger ability at hazard perception. On the other hand, the Systemizing function may weaken hazard perception ability when Empathizing is weak, although it does not have an independent effect.     

Spatio-temporal accident analysis for accident prevention in relation to behavioral factors in driving: The case of South Anatolian Motorway

Analyzing the pattern of traffic accidents on road segments can highlight the hazardous locations where the accidents occur frequently and help to determine problematic parts of the roads. The objective of this paper is to utilize accident hotspots to analyze the effect of different measures on the behavioral factors in driving. Every change in the road and its environment affects the choices of the driver and therefore the safety of the road itself. A spatio-temporal analysis of hotspots therefore can highlight the road segments where measures had positive or negative effects on the behavioral factors in driving. In this paper 2175 accidents resulted in injury or death on the South Anatolian Motorway in Turkey for the years between 2006 and 2009 are considered. The network-based kernel density estimation is used as the hotspot detection method and the K-function and the nearest neighbor distance methods are taken into account to check the significance of the hotspots. A chi-square test is performed to find out whether temporal changes on hotspots are significant or not. A comparison of characteristics related driver attributes like age, experience, etc. for accidents in hotspots vs. accidents outside of hotspots is performed to see if the temporal change of hotspots is caused by structural changes on the road. For a better understanding of the effects on the driver characteristics, the accidents are analyzed in five groups based on three different grouping schemes. In the first grouping approach, all accident data are considered. Then the accident data is grouped according to direction of the traffic flow. Lastly, the accident data is classified in terms of the vehicle type. The resultant spatial and temporal changes in the accident patterns are evaluated and changes on the road structure related to behavioral factors in driving are suggested.