Association of cyclists’ age and sex with risk of involvement in a crash before and after adjustment for cycling exposure

This study aimed to estimate the association of cyclists’ age and sex with the risk of being involved in a crash with and without adjustment for their amount of exposure. We used the distribution of the entire population and cyclists (total and non-responsible) involved in road crashes in Spain between 1993 and 2009 held by the Spanish National Institute of Statistics and the Spanish General Traffic Directorate to calculate rates of exposure and involvement in a crash. Males aged 45–49 years were used as the reference category to obtain exposure rate ratios (ERR) and unadjusted crash rate ratios (URR). We then used these values in decomposition analysis to calculate crash rate ratios adjusted for exposure (ARR). The pattern of ARR was substantially different from URR. In both sexes the highest values were observed in the youngest age groups, and the values decreased as age increased except for a slight increase in the oldest age groups. In males, a slight increase in the lowest and highest age categories was observed for crashes resulting in severe injury or death, and a decrease was observed for the youngest cyclists who were wearing a helmet. The large differences between age and sex groups in the risk of involvement in a cycling crash are strongly dependent on differences in their exposure rates. Taking exposure rates into account, cyclists younger than 30 years and older than 65 years of age had the highest risk of being involved in a crash.     

Relationship between types of head injury and age of pedestrian

This paper explores the relationship between age and the different types of head injury received by pedestrians in traffic accidents with cars. The analysis is based on information collected by hospitals in England, and is supported by in-depth case examples. The principle result is that the risk of intracranial injury increases with age, whilst the risk of fracture to the head or facial bones remains relatively constant. This agrees with previous findings for other groups of casualties, which have reported that that the decrease in brain size leads to an increase in the relative motion of the skull and brain in an impact, with a corresponding increase in the risk of traumatic brain injury. Intracranial injuries have also been found to place the greatest burden on hospitals, which may have implications on automotive design if prevention of these injuries is to be prioritised over fractures of the skull.     

Gender and age distribution of occupational fatalities in Taiwan

This study analyzed fatal occupational injuries in Taiwan. One thousand eight hundred ninety work-related accident reports filed in the years 1996-1999 were extracted from the annual publication of the Council of Labor Affairs (CLA). These data were analyzed in terms of gender, age and work experience of the accident victim as well as accident type and the work-related source of injury to identify significant contributing factors. The CLA data showed that work-related falls were the leading cause of work-related fatalities in both male and female workers (38.2% of male victims and 39.2% of female victims). Gender differences were also noted in the accident type and age of the injured workers. Male workers had a significantly higher prevalence of fatal occupational injuries than female workers throughout the analyzed period (7.4 compared to 0.9 per 100,000 full-time workers). Young males aged 24 years or less had the highest rate of fatal occupational injuries. The finding that gender and age are major factors in occupational injuries is a significant finding in the field of occupational safety and may be helpful for developing accident prevention programs.     

Comparison of two methods to assess the effect of age and sex on the risk of car crashes

Background

This study was designed to compare two methods (direct measurement of exposure and quasi-induced exposure) for assessing the effect of age and sex on the risk of being involved in a car crash in Spain.

Methods

Spanish crash rates (per 10,000,000 driver-km) for age and sex groups of drivers aged 18–64 years old were obtained for 2004–2007, using information from the Spanish General Traffic Office (census of reported car crashes) and the Spanish Household Survey on Alcohol and Drugs (estimate of the mean km driven for each car driver). The rate ratios estimated by direct exposure estimates were compared to those obtained with the quasi-induced exposure method, which compares the age and sex of responsible and non-responsible drivers involved in the same clean collision (in which only one of the drivers committed a driving infraction).

Results

Both methods detected an increased risk of involvement in a crash for the youngest (18–20 years) and the oldest drivers (60–64 years), compared to middle-aged drivers (45–49 years). However, the rate ratios obtained with the quasi-induced method for the youngest group (2.0 for men, 1.6 for women) were much lower than those obtained with crash rates (13.4 for men, 5.7 for women). Both methods detected a similar increase in the risk of involvement of male drivers compared to women in the youngest age group. This excess risk for men was maintained with increasing age up to 45–49 years when the quasi-induced method was used. However, direct comparisons of crash rates revealed an increased risk of involvement in women compared to men of the same age from 25–29 years onward.

Conclusions

Both direct measurement of driving exposure and the quasi-induced exposure method detected some well-known patterns of risk associated with driver's age and sex. However, factors that could explain important differences between the two methods deserve attention, especially those related with the excess risk for the youngest drivers as well as sex-related risk.     

The association of age, sex and helmet use with the risk of death for occupants of two-wheeled motor vehicles involved in traffic crashes in Spain

Background

This study was designed to separate the association of age, sex and helmet use with the risk of death for occupants of two-wheeled motor vehicles (TWMV) involved in crashes into its two theoretical components: severity of the crash and occupant resilience.

Methods

We analyzed the retrospective cohort comprising all 48 016 pairs of drivers and passengers aged 14 years or more in TWMV involved in crashes with victims in Spain from 1993 to 2007 recorded in the Spanish traffic crash registry. The outcome (death or survival), age, sex and helmet use was known for both occupants. Adjusted relative risks (RR) for the association of age, sex and helmet with the risk of death were calculated with Poisson regression models.

Results

Each 1-year increase in age was related with a 3% increase in the risk of death related with lower resilience. The severity-dependent RR of death was 1.84 for male sex and 0.86 for non-helmet use, and the resilience-dependent RR was 0.72 and 2.53, respectively.

Conclusions

The direction and magnitude of the association between age, sex and helmet use and the risk of death of an occupant of a TWMV involved in a crash changed depending on which component of risk was considered: crash severity or occupant resilience. Specifically, female sex and non-helmet use seemed to be associated with crashes of lower severity, but together with increased age they were also related with lower resilience to the energy released in the crash, and therefore with a higher risk of death after adjustment for crash severity. This should be taken into account when assessing the association of individual factors with the risk of death after a crash.     

Prognostic factors for chronic neck pain in persons with minor or moderate injuries in traffic accidents

Prognostic factors for chronic neck pain were identified in a prospective Norwegian insurance cohort comprising 636 persons with minor or moderate traffic injuries. One questionnaire was used at baseline and another at 3 years post-injury. Daily severe or very severe neck pain at three years follow up was defined as chronic neck pain. Eight significant independent prognostic factors for chronic neck pain were identified: (1) rear-end or frontal and rear-end collision, odds ratio (OR): 4.10 (95% confidence interval (CI): 1.72-10.82); (2) neck and/or shoulder pain before the accident, OR: 2.38 (95% CI: 1.07-5.37); (3) post-accident (a) memory and concentration problems, OR: 4.62 (95% CI: 1.99-11.20), (b) bodily tension, OR: 3.43 (95% CI: 1.49-8.42), (c) difficulties to climb stairs, OR: 5.03 (95% CI: 1.77-14.95), (d) difficulties to bend forward, OR: 4.85 (95% CI: 2.06-11.79), (e) difficulties to do heavy labour, OR: 3.70 (95% CI: 1.24-11.64); (4) beliefs in future work disability, OR: 2.64 (95% CI: 1.11-6.48). The results indicate that development of chronic neck pain is influenced by pre-accident neck and/or shoulder pain, the impact of the collision, as well as post-accident symptoms, perceived impaired function and pessimism for the future ability to work.     

Preferences for lives, injuries, and age: A stated preference survey

One of the more difficult ethical questions from a public decision-making perspective is whether the estimation of benefits from risk reducing projects should be influenced by factors such as age groups and risk domains. For example, should a project that saves the lives of elderly people be assigned a more different benefit value in cost-benefit analyses than one that saves the same number of children's lives? This paper examines the preferences of the general public in Sweden on these issues. We design a choice experiment in which subjects are required to make six pair-wise choices where the characteristics of each choice are accident type (fire and traffic), number of fatalities and serious injuries avoided, and age of those saved (5–15-, 35–45- and 65–75-year-olds). We find that avoiding the fatality of one 5–15-year-old is equivalent to avoiding 1.4 fatalities of 35–45-year-olds. Likewise, avoiding the fatality of one 5–15-year-old is equivalent to avoiding 3.3 fatalities of 65–75-year-olds. We find no significant differences between the causes of accident. One avoided fatality is found to be equivalent to around 3.5 avoided severe injuries, which is lower than the official value of 6 used by the Swedish Road Administration.     

A review of risk factors and patterns of motorcycle injuries

Per vehicle mile traveled, motorcycle riders have a 34-fold higher risk of death in a crash than people driving other types of motor vehicles. While lower-extremity injuries most commonly occur in all motorcycle crashes, head injuries are most frequent in fatal crashes. Helmets and helmet use laws have been shown to be effective in reducing head injuries and deaths from motorcycle crashes. Alcohol is the major contributing factor to fatal crashes. Enforcement of legal limits on the blood alcohol concentration is effective in reducing motorcycle deaths, while some alcohol-related interventions such as a minimal legal drinking age, increased alcohol excise taxes, and responsible beverage service specifically for motorcycle riders have not been examined. Other modifiable protective or risk factors comprise inexperience and driver training, conspicuity and daytime headlight laws, motorcycle licensure and ownership, riding speed, and risk-taking behaviors. Features of motorcycle use and potentially effective prevention programs for motorcycle crash injuries in developing countries are discussed. Finally, recommendations for future motorcycle-injury research are made.     

Decreasing number of young licence holders and reduced number of accidents. A description of trends in Sweden

The following study compares rates of licence holders and rates of car accidents in two age cohorts born in Sweden in 1972 and 1977, respectively. The research material consists of all accidents with injury which these young people have been involved in as car drivers at age 16–21. The periods concerned are 1988–1993 and 1993–1998, respectively. In the respective periods altogether 2082 and 1453 car accidents leading to injury were recorded. The results show a lower rate of licence holders and a lower rate of car accidents in the later age cohort. Particularly the rate of fatal accidents and accidents leading to serious injury was lower. Comparing the earlier with the later age cohort, the reduction of accidents was greatest in the most densely built-up counties of Sweden and in the groups with the highest risk, namely those age and socio-economic groups who had the highest rate of fatalities and accidents leading to serious injury. Factors behind the decrease in the rates of licence holders and the rates of car accidents are discussed. Recession in the economy and less interest in car driving among young people are factors which are suggested as explanations.     

Gender differences in road traffic injury rate using time travelled as a measure of exposure

There is no consensus on whether the risk of road traffic injury is higher among men or among women. Comparison between studies is difficult mainly due to the different exposure measures used to estimate the risk. The measures of exposure to the risk of road traffic injury should be people's mobility measures, but frequently authors use other measures such population or vehicles mobility. We compare road traffic injury risk in men and women, by age, mode of transport and severity, using the time people spend travelling as the exposure measure, in Catalonia for the period 2004–2008. This is a cross-sectional study including all residents aged over 3 years. The road traffic injury rate was calculated using the number of people injured, from the Register of Accidents and Victims of the National Traffic Authority as numerator, and the person-hours travelled, from the 2006 Daily Mobility Survey carried out by the Catalan regional government, as denominator. Sex and age specific rates by mode of transport and severity were calculated, and Poisson regression models were fitted. Among child pedestrians and young drivers, males present higher risk of slight and severe injury, and in the oldest groups women present higher risk. The death rate is always higher in men. There exists interaction between sex and age in road traffic injury risk. Therefore, injury risk is higher among men in some age groups, and among women in other groups, but these age groups vary depending on mode of transport and severity.     

Association between major injuries and seat locations in a motorcoach rollover accident

Motorcoaches and buses have the highest accident rate among different kinds of vehicles in Taiwan. It is, therefore, important to modify motorcoach designs so that they increase passenger safety. We collected patient data from a motorcoach rollover accident to assess the major injuries of the passengers and the associated risk factors for each type of injury. The accident occurred on a summer day in 2003 in central eastern Taiwan. A double-decker motorcoach carrying 46 passengers and a driver rolled over onto its left side on a downhill path because the coach's brakes failed. On the upper deck, the coach had four columns of seats, two on either side of a center aisle: 12 pairs on the left side, and 10 pairs on the right. Of the 41 seated people on the upper deck, the passengers in the down side (left seats) of each pair of seats had higher Injury Severity Scores than those in the up side (right seats), and passengers >or=65 years old had relatively higher rates of hemothorax and head injuries with subarachnoid hemorrhage or intracranial hemorrhage than those <65. Multivariate analysis showed that age >or=65 years and sitting on the down side at the time of rollover were independent risk factors for major injuries. Our analysis of the data from this motorcoach rollover accident showed that most major injuries occurred as passengers in the up side seats were thrown from their seats and compressed the neighboring passengers in the down side. We hypothesize that occupant restraint devices, such as seat belts, might prevent or reduce some injuries in motorcoach rollover accidents.     

Economic consequences of injury and resulting family coping strategies in Ghana

The toll of human suffering from illness and injury is usually measured by mortality and disability rates. Economic consequences, such as treatment costs and lost productivity, are often considered as well. Lately, increasing attention has been paid to the economic effects of illness on a household level. In this study, we sought to assess the economic consequences of injuries in Ghana by looking at the effects on households and the coping mechanisms these households employed. Using cluster sampling and household interviews, we surveyed 21,105 persons living in 431 urban and rural sites. We sought information on any injury that occurred to a household member during the prior year and that resulted in one or more days of disability time.A total of 1609 injuries were reported for the prior year. Treatment costs and disability days were higher in the urban area than in the rural. Coping strategies were different between the two areas. Rural households were more likely to utilize intra-family labor reallocation (90%) than were urban households (75%). Rural households were also more likely to borrow money (24%) than were urban (19%). Households in both areas were equally likely to sell belongings, although the nature of the belongings sold were different. Although injuries in the urban area had more severe primary effects (treatment cost and disability time), the ultimate effect on rural households appeared more severe. A greater percentage of rural households (28%) reported a decline in food consumption than did urban households (19%). These findings result in several policy implications, including measures that could be used to assist family coping strategies and measures directed toward injuries themselves.     

Factors associated with fatal and injurious car crash among learner drivers in New South Wales,Australia

This exploratory study investigated factors associated with car crash injury among learner drivers across difference ages by using data routinely collected by the NSW police. The results obtained indicated that some factors are commonly associated with car crash injury across nearly all ages. On the other hand, some others are more age specific. On the whole, female learner drivers were more at risk of being killed or injured as compared to males. The drivers of 16 years old had an increased risk of crash injury due to environmental factors, such as special road feature, and distraction outside the vehicle. The increased risk of crash injury for older drivers (> or =25 years) was associated with distractions from both inside and outside vehicle. Night time driving posed a special risk to learner drivers aged 20-24 years old, but not other age groups. Speeding was a common factor for the increased risk of crash injury across all age groups. The implication of the results and limitations of the study were discussed.     

人工诱导点带石斑鱼性逆转的组织学证据及其机制探讨

对外源混合激素药条肌体埋植法诱导点带石斑鱼提早性逆转的发育过程进行了组织学观察,结果表明：(1)3-5龄的雌鱼能在50-70天内转变为功能性雄鱼,年龄较小的雌鱼性转时间相对长些。(2)性转雄鱼精巢组织的雄性生殖细胞包括：精原细胞、初级精母细胞、精子细胞和精子,精子头部呈球型直径约1．5-2．5μm．尾长12．4-44．5μm,与天然雄鱼相似。(3)人工诱导性转雄鱼可取代天然雄鱼进行人工繁殖。(4)点带石斑鱼的性逆转机制为性类固醇依赖型。外源雄性激素通过抑制“雌性相关基因”的表达,而成为石斑鱼性逆转的启动因子,诱发卵巢退化和精巢的发育,直至精子生成。     

Firearm storage practices and rates of unintentional firearm deaths in the United States

BACKGROUND: The American Academy of Pediatrics and the American Medical Association recommend storing firearms unloaded and locked up to minimize the chance of injury. Although these recommendations appeal to common sense, no study has yet addressed whether firearm storage practices influence the risk of unintentional firearm injury. METHODS: Negative binomial regression analyses were used to assess the cross sectional relation between firearm storage practices and rates of unintentional firearm death in the United States, controlling for rates of firearm prevalence, poverty and urbanization. Recently available state-level measures of household firearm prevalence and firearm storage practices were obtained from the 2002 Behavioral Risk Factor Surveillance System. Unintentional firearm death counts and population data came from the National Center for Health Statistics. RESULTS: Independent of firearm prevalence, urbanization, and poverty, a disproportionately large share of unintentional firearm fatalities occurred in states where gun owners were more likely to store their firearms loaded, the greatest risk occurring in states where loaded firearms were more likely to be stored unlocked. CONCLUSION: Our findings provide empirical support for recommendations issued by the AMA and the AAP that firearms should be stored unloaded and locked, and suggest that promoting safer storage practices could save many lives.     

Incidence and costs of bicycle-related traumatic brain injuries in the Netherlands

The main cause of death and serious disability in bicycle accidents is traumatic brain injury (TBI). The aim of this population-based study was to assess the incidence and costs of bicycle-related TBI across various age groups, and in comparison to all bicycle-related injuries, to identify main risk groups for the development of preventive strategies.Data from the National Injury Surveillance System and National Medical Registration were used for all patients with bicycle-related injuries and TBI who visited a Dutch emergency department (ED) between 1998 and 2012. Demographics and national, weighted estimates of injury mechanism, injury severity and costs were analysed per age group. Direct healthcare costs and indirect costs were determined using the incidence-based Dutch Burden of Injury Model.Between 1998 and 2012, the incidence of ED treatments due to bicycle-related TBI strongly increased with 54%, to 43 per 100,000 persons in 2012. However, the incidence of all bicycle-related injuries remained stable, from 444 in 1998 to 456/100,000 in 2012. Incidence of hospital admission increased in both TBI (92%) and all injuries from cycling (71%). Highest increase in incidence of both ED treatments and hospital admissions was seen in adults aged 55+. The injury rate of TBI per kilometre travelled increased (44%) except in children, but decreased (−4%) for all injuries, showing a strong decrease in children (−36%) but an increase in men aged 25+, and women aged 15+. Total costs of bicycle-related TBI were €74.5 million annually. Although bicycle-related TBI accounted for 9% of the incidence of all ED treatments due to cycling, it accounted for 18% of the total costs due to all bicycle-related injuries (€410.7 million). Children and adolescents (aged 0–24) had highest incidence of ED treatments due to bicycle-related injuries. Men in the working population (aged 15–64) had highest indirect costs following injuries from cycling, including TBI. Older cyclists (aged 55+) were identified as main risk group for TBI, as they had highest ED attendance, injury rate, injury severity, admission to hospital or intensive care unit, and costs.Incidence of ED treatments due to cycling are high and often involve TBI, imposing a high burden on individuals and society. Older cyclists aged 55+ were identified as main risk group for TBI to be targeted in preventive strategies, due to their high risk for (serious) injuries and ever-increasing share of ED visits and hospital admissions.     

Effects of age heat treatment and thermomechanical processing on microstructure and mechanical behavior of LAZ1010 Mg alloy

An Mg–Li–Al–Zn (designated as LAZ1010) alloy containing about 10 wt% of Li has been prepared by melting and solidification in a carbon steel crucible, and extruded at a billet preheating temperature of 200 °C with an extrusion ratio of approximately 29. Effects of age heat treatments and thermomechanical processing on microstructures and mechanical properties were performed in this study. Hardness, optical microscopy, X-ray diffraction studies, and tensile testes were carried out to explore the variations in microstructures and mechanical behaviors during processing. The results showed that LAZ1010 alloy presented age hardening effect at temperatures below 50 °C. Rapid decrease in hardness with aging temperature at intermediate temperatures should be resulted from the transformation of θ phase into the equilibrium phase AlLi. Kocks–Mecking type plots were used to illustrate different stages of work hardening of the cold rolled specimens. The results indicated that cold rolled LAZ1010 alloy showed stage III and stage IV work hardening behaviors.     

安徽省城乡居民交通事故死亡状况及对策

安徽省 1 990～ 1 992年城乡居民死亡原因抽样调查结果显示 ,全省目前的交通事故死亡率年平均为 9.2 0 /1 0万 ,每年因交通事故死亡约 5 0 0 0人 ,城市的交通事故死亡率为 1 0 .0 5 /1 0万 ,居意外死因的首位 ;农村的交通事故死亡率为 9.0 3 /1 0万 ,居意外死因的第 3位 ,从死亡水平和死者的性别、年龄特征来看 ,城乡的死亡状况已十分相似。总体来看 ,男性交通事故死亡率明显高于女性 ;分年龄组看 ,随着年龄的增加 ,死亡率逐渐上升 ,但 2 0～ 60岁的死亡人数占全部交通事故死亡的 66.0 4%。结果表明 ,安徽省目前城乡居民的交通事故死亡状况是很严重的 ,大力加强全省交通安全管理。提高全民的交通安全意识是迫切需要解决的问题。     

Sleepiness in professional drivers: effect of age and time of day

The effect of age and time of day on objective and subjective sleepiness in professional drivers was investigated during a simulated driving task. Thirty-six young and middle-aged professional males drivers, free from any sleep disorder, took part in two simulated driving sessions; one carried out in the afternoon (between 2 and 4 p.m.) the other in the evening (between 11 p.m. and 1 a.m.). Half of each age group drove in a low traffic condition while the second half drove in a heavy traffic condition. Throughout the driving task, subjects' electroencephalogram and Karolinska sleepiness scale (KSS) scores were recorded. Visual analog scales measuring alertness and sleepiness levels were also completed before and after the driving. After each session, subjects filled out the NASA-TLX questionnaire and were asked if they had felt sleepy during the driving. Young professional drivers presented a significant decrease in alertness (raise of the spectral power in the alpha band) in the low traffic condition and a strong propensity to sleep during the evening test in contrast to middle-aged professional drivers.     

Unintentional injuries at school in China--patterns and risk factors

OBJECTIVE: To describe the rate and pattern of unintentional school injuries among primary and middle school students and to explore the major risk factors involved. STUDY DESIGN: A cross-sectional survey of more than 10,000 students attending 6 primary and 4 middle schools selected randomly from all schools in Maanshan City of Anhui Province in eastern China was conducted to collect information on school injuries occurring in the 12-month period before the survey. Rate ratios for risk factors were estimated using the negative binomial regression analysis. RESULTS: The annual person-based school injury rate was 5.22 (95% CI: 3.90-6.53) percent. The annual event-based injury rate was 5.40 (95% CI: 4.04-6.76) per 100 students. Most injuries in school were relatively mild and only 1.53% (9/590) of the episodes resulted in hospitalization. The most frequent injures were falls (73%), and the most commonly injured sites were the upper limbs (46%). Male sex, primary school grades, poor health status, poor ability to concentrate, bad risk-taking behavior and high study-related stress were important risk factors. CONCLUSION: This study provided useful baseline information on school injuries in China and identified important risk factors that would be important in planning prevention strategies.