Estimates of motor vehicle seat belt effectiveness and use: implications for occupant crash protection

Estimates of the effectiveness of seat belts, when used, in reducing motor vehicle occupant deaths vary widely. A recently publicized claim by one analyst that seat belts reduce vehicle occupant deaths 70-80 per cent is based on studies found to contain fundamental systematic error. Deaths occur only 50 per cent less often to belted compared to nonbelted vehicle occupants in crashes, according to previously unanalyzed data from three U.S. states during recent years. New belt systems would be about 60 per cent effective with 100 per cent use. But surveys of observed belt use in 1975 U.S. cars indicate that two-thirds of drivers were not using belts. Prospects for widespread adoption and enforcement of belt use laws in the U.S. are not encouraging. Substantial reductions in fatal and other injuries would result from the adoption of requirements mandating automatic (passive) protection for front seat occupants in crashes with forward decelerations.     

Look who's driving now--visual standards for driver licensing in the United States

The current visual standards for driver licensing of the general population in all 50 states and the District of Columbia are described. Minimum visual acuity standards range from 20/40 (73%) to vision less than 20/200 (Washington). The majority of states (92%) offer some type of restricted license which provide an opportunity for low vision drivers to keep their independence while at the same time affording society a high level of safety in the driving system. Tips for the ophthalmic nurse are provided.     

Comparison of young and adult driver crashes in Alaska using linked traffic crash and hospital data

This report describes young driver crashes in Alaska, compares rates and characteristics of young driver crashes with adult driver crashes, and summarizes the medical and financial outcomes of young driver crashes, for the period 1991 through 1995. Using the Mini Crash Outcome Data Evaluation System (MINICODES), trauma registry hospital discharge data were linked with traffic crash records. The data were analyzed to compare drivers aged 16-20 with drivers aged 21-50 who were involved in a crash resulting in the hospitalization or death of a crash victim. The CrashCost Program was used to estimate costs associated with young driver crashes for the five years. Young drivers were 2.9 times more likely than adult drivers to be involved in crashes that resulted in the hospitalization of a crash victim, and 2.6 times more likely to be involved in a crash involving a fatality. The contributing factors for young driver crashes were listed as human factors 73.4% of the time, compared with 65.6% among adults (P = .001). Costs associated with the young driver crashes were estimated to be over $300 million, which resulted in a cost per young licensed driver that was 3.4 times the cost per adult licensed driver.     

Mosquito fauna (Diptera:Culicidae) from Falcon State, Venezuela. I. New records and current checklist

A Markov model was used to assess the cost-benefit ratios of six strategies of screening older drivers for mental status, beginning at age 65. Probabilities of motor vehicle collisions (MVCs), injuries, and fatalities were obtained from national data. Dementia prevalence, test characteristics, and costs were obtained from the literature. Costs included lost wages, car ownership, alternative transportation, and injuries. Using a relative risk of MVC for those with dementia of 5 and a 5% annual discounting rate, the average cost per driver ranged from $51,600 (no testing) to $58,400 (testing every five years). The benefit was < one day of life gained, and the benefits of screening cost approximately 2.8 million dollars per life-year gained. Increasing the relative risk from 5 to 20 substantially improved the cost-benefit of mental status screening. However, mental status screening of older drivers would also be cost-beneficial if physician referral costs were lowered to $60 per evaluation. The authors conclude that a dementia screening program for older drivers would be cost-beneficial if physician evaluations were limited or their cost lowered to < or = $60.     

Molecular characterization of erythrocyte glucose-6-phosphate dehydrogenase deficiency in Al-Ain District, United Arab Emirates

Operational skills involved in controlling a motor vehicle were measured in two groups of very healthy elderly drivers and a young control group to test the hypothesis that there are age-related declines in operational performance that may influence driver safety. An actual behind-the-wheel, standardized road test was employed using a motor vehicle equipped with sensors to record speed, braking activity, and lane position, as well as direction and magnitude of front-wheel and eye-movement excursions. The data from these sensors were used as dependent measures of operational performance. Older drivers made fewer steering and eye-movement excursions and drifted across the center line more frequently than the young control group. Younger drivers drove significantly faster and executed more braking applications than did their older counterparts. The motor-vehicle operational performance of older healthy drivers was related to visual-spatial attentional declines and the useful field of vision associated with the normal aging process.     

Variable cerebral responses to equally distinct deviance in four auditory dimensions: a mismatch negativity study

This paper uses regression models to investigate the efficacy of the seat belt regulation as well as the circuit training and testing system in reducing traffic related fatalities in Singapore. The effectiveness of alcohol breathalysers was also studied. Results suggest that the seat belt regulation does not have any impact on traffic fatalities. The use of breathalysers was found to be effective in reducing occupant fatalities. The circuit training and testing system, which aims to equip new pools of motorists with appropriate driving or riding skills, was found to be effective in reducing non-occupant fatalities and total fatalities.     

Does license disqualification reduce reoffence rates?

A review was conducted of the subsequent driving records of over 25,000 Queensland drivers cited for a drink driving offence in 1988 who received at least one subsequent license restriction. The interval of follow-up was at least 3 years, average 3.9 years. Periods of driving disqualification were identified and, for each driver, the total amount of time during restricted and unrestricted driving was computed; the numbers of events, i.e. crashes and traffic offences, recorded during these periods were counted. Rates under disqualification and during legal driving, expressed per thousand person-years were derived by dividing total numbers of events by total time during which they could occur. Three categories of traffic violation were considered: drink driving offences; traffic offences unassociated with drink driving, and any offence involving driving. Since only 12% of the offenders and 9% of the reoffenders were female, detailed analyses are presented for men only; results for women were little different. Statistical inference assumed a Poisson model for crashes and a negative binomial model for offences, and analyses were performed after stratification by number of drink driving offences. Calculated rates during periods of disqualification were about one third of the rates during legal driving for crashes and all three categories of traffic offence, ranging from 25% in the case of unassociated offences to 35% for any driving offence. There were differences, some statistically significant, by age and between metropolitan, provincial city and rural regions of the State, but most were relatively minor. Drivers were apprehended more frequently earlier in the disqualification period than later. It is impossible from these data to distinguish between reduced driving levels and more cautious traffic behaviour during periods of license restriction. It is nonetheless clear that while such penalties are in operation, they substantially reduce the negative impact of convicted drink-drivers on the road. Unfortunately the data do not permit one to say whether or for how long the effect persists.     

Trends in motorcyclist and occupant fatalities and serious injuries due to traffic crashes

AIM: To describe trends in motorcycle traffic crashes and compare these trends in other crashes and vehicle registrations. METHOD: National fatality and public hospital inpatient data were used to select cases. Relative changes in both deaths and hospitalisations, and vehicle registrations were examined in each year during the period 1980-98. RESULTS: The results show that deaths and serious injuries to motorcyclists have declined substantially over the period 1980-1995. The trend in serious injuries to motorcyclists closely followed the trend in motorcycle registrations. The association was less evident for motorcyclist fatalities and for occupants there was no clear association with trends in registrations for either outcome. CONCLUSIONS: The reduction in motorcycle injuries has contributed substantially to our improved road safety record. We need to protect these gains but in order to do this we need a clear understanding of how they were achieved. Such an understanding is currently lacking.     

Diabetic foot ulcers: current concepts

OBJECTIVE: To determine whether a Maine law lowering the legal blood alcohol limit (BAL) from 0.10% to 0.05% for people convicted of driving while intoxicated (DWI) reduced the involvement of this group in fatal crashes. METHODS: The authors calculated changes in the proportions of fatal crashes involving drivers with prior DWI convictions from the six-year period before enactment of the law to the six-year period following enactment of the law, comparing Maine with the other New England states. RESULTS: In Maine, the proportion of fetal crashes involving drivers with recorded prior DWI convictions declined 25% following passage of the 0.05% DWI law, while the proportion rose in the rest of New England during the same years. The proportion of fatal crashes involving drivers with recorded prior DWI convictions and illegal alcohol levels also declined significantly in Maine, as did the proportion of fatal crashes involving fatally injured drivers with recorded prior DWI convictions and illegal alcohol levels. Most of the latter decline was due to a decline in alcohol-related fatalities of previously convicted drivers with very high BALs, of 0.15% or higher, at the time of the fatal crash. Each of these declines in Maine was significant relative to the rest of New England. CONCLUSION: Other states should consider instituting 0.05% BAL limits for convicted DWI offenders.     

Epidemiology of work-related aviation fatalities in Alaska, 1990-94

Alaska, with less than one-half of 1% of the United States workforce, accounts for 9% of all occupational aviation fatalities nationally; 30% of all occupational fatalities in Alaska are related to aviation. To understand this high mortality, we investigated occupational aviation crashes to identify risk factors. Occupational aviation fatalities in Alaska during 1990-94 were examined using National Transportation Safety Board reports and merged with records from the Alaska Occupational Injury Surveillance System. There were 876 aircraft crashes; 407 (46%) were work-related. Occupational crashes were 2.2 times (CI: 1.5, 3.2) more likely to result in fatalities than non-occupational crashes. Risk factors identified included poor weather conditions defined as Instrument Meteorological Conditions (IMC). A crash during IMC was 5.3 times (CI: 3.5, 7.9) more likely to result in fatalities than crashes in other conditions. Of aircraft involved in fatal occupational incidents, 33% were not completely destroyed, allowing the potential for survivors. An estimated 30% reduction in fatalities could have occurred if current technology in occupant protection had been used.     

Alcohol intake and severity of injuries on highways in Mexico: a comparative analysis

AIMS: To analyze the association between alcohol intake and the severity of injuries sustained from traffic accidents on a Mexican highway. DESIGN: An observational unit evaluated drivers involved in auto accidents. SETTING: Mexico-Cuernavaca Highway, Mexico. A 60 km-long road with many altitude variations and sharp curves. PARTICIPANTS: Three hundred and eighty-six drivers involved in traffic accidents between March and September, 1994. MEASUREMENTS: A questionnaire was applied to the driver, an occupant or witness at the site of the accident to collect information about the driver, vehicle characteristics, type of accident, day-night occurrence, road section (Mexico-Cuernavaca or Cuernavaca-Mexico) and weather conditions. A physical examination was carried out to determine the presence and severity of injuries. FINDINGS: There were 177 injured people, including 12 deaths, with rates of 67.5 injuries and 4.58 deaths per 10,000 km driven. Variables associated with alcohol intake (p < 0.05) included: severity of injuries, non-use of seat belt, vehicle size and occurrence at night. Risk factors for severe injuries were: alcohol intake (adjusted OR 6.1 CI 95% 1.6-24.0); non-use of seat belt (OR 4.9 CI 2.2-10.8), age < 25 years (OR 3.6 CI 1.0-12.7), age > 54 years (OR 6.0 CI 1.4-25.0), speed > 90 km/h (OR 2.6 CI 1.1-6.3) and occurrence at night (OR 2.6 CI 1.3-5.3). CONCLUSIONS: Alcohol intake is a major risk factor for severe injuries from highway traffic accidents. Its association with other risk factors such as non-use of seat belt and excessive speed suggests the importance of designing interventions aimed at reducing alcohol intake among automobile drivers.     

Effects of amniotic fluid embolism-like plasma on isolated perfused rabbit lungs

Information on road injury with analyses on the epidemiological features and determinants of fatality rate with prevention and control of road injury was presented in this paper. From 1951 to 1994, road injury and motor vehicle deaths had a continuous increase by 43 and 78 times respectively. Since 1987 about 250,000 cases, 5000 deaths and 15,000 trauma cases caused by road crashes year after year. The fatality rate increased by an average of 12.9% increase per year from 1984 to 1994 (from 2.43 to 5.56 per 100,000 pop). Zhejiang, Guangdong, Liaoning, Sichuan and Jiangsu occupied the first five places in 30 provinces, accounted for over 45% of total road injuries and one thirds of road fatalities. Both incidence and death rate were lowest in Beijing City and highest in Zhejiang Province. Three-quarters of the fatality on road injury were occurred on smooth and straight pavement in sunny days. Over 60% of the motor vehicle deaths were young males (age 20-50 yrs). Classified by occupation, majority of the victims were peasants (55%) and workers (19%). Two thirds of the road fatalities were pedestrians, bicycle riders and passengers. Human factors including driver's irresponsibility, non-licensing, bicycle rider and pedestrian carelessness, etc. were notified that accounted for over 90% of the causes for road injury. Primary causes from the drivers were rules and regulations violation, absent-mindedness, driving after drinking alcohol. The risk factors of road injuries were the increase of motor vehicles and traffic congestion. It is also necessary to improve the traffic safety knowledge among residents.     

Long-term follow-up of cytostatic intravesical instillation in patients with superficial bladder carcinoma. Is short-term, intensive instillation better than maintenance therapy?

Change of road user attitudes is often advocated as a necessary condition for improvement of road safety. The relation between road user attitudes and accident risk is, however, not well known in road safety research. The objective of this study was to find out whether attitudes are of importance to road safety, i.e. the hypothesis is that drivers having attitudes considered correct according to the traffic code, have lower accident risk than other drivers. The attitudes of a representative sample of Norwegian driver's license holders as well as their accident involvement and driving distance were surveyed by mail questionnaires in two phases. When no other factor is taken into account, accident risk is found to be affected by driver attitudes. When, on the other hand, the age of drivers is taken into account, the relation between attitudes and accident risk disappears. It is concluded that age and annual mileage are more important to accident risk than are attitudes, and more knowledge of the relationship between attitudes and road accident risk is needed.     

Fine needle aspiration of the breast. A probabilistic approach to diagnosis of carcinoma

European signing policy favours uncontrolled intersections--a trend which is in marked contrast to the U.S.A. policy. European drivers must constantly keep in mind the general rule of priority at cross-roads which requires one to yield to a vehicle coming from the right, if not otherwise indicated. For a European driver, an uncontrolled junction means an obligation to yield to vehicles on the right while for U.S. drivers, adapted to the U.S.A. system with more frequent signing, an intersection unsigned from his direction suggests priority for him, particularly in an urban area. To demonstrate a safety problem which follows, three American subjects, visiting professors without previous experience of driving in Europe, were asked to drive a 1.8 km route six times with an instrumented car in the downtown area of Helsinki. All of them first showed unsafe driving practices at uncontrolled intersections with restricted visibility in comparison to a local control group, but changed their strategy, both in terms of speed control and visual search, after they had been informed of the European rule of crossroad priority. In spite of the same general rule at blind intersections in a similar urban environment, a different signing policy may cause safety problems for American drivers in Europe, and translate into more accidents at non-priority intersections. Varying rules and practices in different jurisdictions call for further efforts in presenting vital information to foreign motorists and striving towards worldwide uniform traffic control.     

Simulated car crashes and crash predictors in drivers with Alzheimer disease

BACKGROUND: Alzheimer disease (AD) is the most common cause of dementia and can impair cognitive abilities crucial to the task of driving. Rational decisions about whether such impaired individuals should continue to drive require objective assessments of driver performance. OBJECTIVE: To measure relevant performance factors using high-fidelity driving simulation. DESIGN: We examined the effect of AD on driver collision avoidance using the Iowa Driving Simulator, which provided a high-fidelity, closely controlled environment in which to observe serious errors by at-risk drivers. We determined how such unsafe events are predicted by visual and cognitive factors sensitive to decline in aging and AD. SETTING: The University of Iowa Hospitals and Clinics, Iowa City, and the Iowa Driving Simulator. PARTICIPANTS: Thirty-nine licensed drivers: 21 with AD and 18 controls without dementia. MAIN OUTCOME MEASURES: We determined the number of crashes and related performance errors and analyzed how these occurrences were predicted by visual and cognitive factors. RESULTS: Six participants (29%) with AD experienced crashes vs 0 of 18 control participants (P = .022). Drivers with AD were more than twice as likely to experience close calls (P = .042). Plots of critical control factors in the moments preceding a crash revealed patterns of driver in-attention and error. Strong predictors of crashes included visuospatial impairment, reduction in the useful field of view, and reduced perception of 3-dimensional structure-from-motion. CONCLUSIONS: High-fidelity driving simulation provides a unique new source of performance parameters to standardize the assessment of driver fitness. Detailed observations of crashes and other safety errors provide unbiased evidence to aid in the difficult clinical decision of whether older or medically impaired individuals should continue to drive. The findings are complementary to evidence currently being gathered using techniques from epidemiology and cognitive neuroscience.     

The stop sign is for the other guy: A naturalistic observation of driving behavior of Nigerians.

Examined the effects of 2 types of stop signs on driving behaviors of private car and commercial vehicle drivers. The Ss were 1,211 male and female Nigerian university students whose driving behaviors were observed as they drove through a complex –T junction. Trained observers recorded how well each driver conformed with the demands of standard traffic regulations. Results show that (a) private car drivers conformed more to traffic regulations than did drivers of commercial vehicles, and (b) drivers who obeyed stop signs tended to make turn signals. Installation of more traffic signs on Nigerian roads and the education of drivers (especially commercial vehicle drivers) as to the specific demands of such traffic signs are advocated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of age, system experience, and navigation technique on driving with an advanced traveler information system

This paper explores the effects of age, system experience, and navigation technique on driving, navigation performance, and safety for drivers who used TravTek, an Advanced Traveler Information System. The first two studies investigated various route guidance configurations on the road in a specially equipped instrumented vehicle with an experimenter present. The third was a naturalistic quasi-experimental field study that collected data unobtrusively from more than 1200 TravTek rental car drivers with no in-vehicle experimenter. The results suggest that with increased experience, drivers become familiar with the system and develop strategies for substantially more efficient and safer use. The results also showed that drivers over age 65 had difficulty driving and navigating concurrently. They compensated by driving slowly and more cautiously. Despite this increased caution, older drivers made more safety-related errors than did younger drivers. The results also showed that older drivers benefited substantially from a well-designed ATIS driver interface.     

Selective induction of apoptosis in mouse and human lung epithelial cell lines by the tert-butyl hydroxylated metabolite of butylated hydroxytoluene: a proposed role in tumor promotion

With increasing age, diseases affecting the cognitive functions are more frequent. These diseases may increase the risk for fatal car crashes. We analyzed the frequency of neuropathological alterations characteristic of Alzheimer's disease (i.e. neuritic and diffuse plaques, and neurofibrillary tangles) in two association areas of the brain, parietal and frontal cerebral cortex, from 98 fatally injured aged drivers. In the age groups of 65-75 and over 75 years of age, 50% and 72% of the drivers, respectively, had neuritic plaques in either parietal and/or frontal cortex. In 14% of all killed drivers the number of neuritic plaques reached the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) age-related histologic score C, which indicates the diagnosis of Alzheimer's disease (AD), and an additional 33% had score B, which suggests the diagnosis of AD. Neuropathological AD changes were most common in the brains of drivers killed in single vehicle crashes, followed by multivehicle crashes at intersections and least common in multivehicle crashes elsewhere, but the differences did not reach statistical significance. In a great majority (80-85%) of cases the killed aged driver was the guilty party of the crash. The results imply, that incipient AD may contribute to fatal crashes of aged drivers, and therefore the forensic autopsy of these victims should include neuropathological examination.     

A microbore high performance liquid chromatography/electrospray ionization mass spectrometry method for the determination of the phytoestrogens genistein and daidzein in comminuted baby foods and soya flour

Motor vehicle crashes are a leading cause of death and disability among children in the United States despite the fact that child safety seats and seat belts can provide effective protection against serious and fatal injuries. Many child car seats and safety restraints are being used incorrectly. In addition, recent fatalities associated with children and air bags have heightened awareness of child passenger safety issues. Pediatric nurse practitioners are in an excellent position to offer motor vehicle occupant prevention strategies to families through health education and anticipatory guidance.     

Improving older drivers' hazard perception ability.

One reason that older drivers may have elevated crash risk is because they anticipate hazardous situations less well than middle-aged drivers. Hazard perception ability has been found to be amenable to training in young drivers. This article reports an experiment in which video-based hazard perception training was given to drivers who were between the ages of 65 and 94 years. Trained participants were significantly faster at anticipating traffic hazards compared with an untrained control group, and this benefit was present even after the authors controlled for pretraining ability. If future research shows these effects to be robust, the implications for driver training and safety are significant. (PsycINFO Database Record (c) 2010 APA, all rights reserved)