Reliability of simulator driving tool for evaluation of sleepiness,fatigue and driving performance

Study objective

To compare the impact of extended wakefulness (i.e., sleepiness) and prolonged driving (i.e., fatigue) at the wheel in simulated versus real-life driving conditions.

Design

Participants drove on an INRETS-MSIS SIM2 simulator in a research laboratory or an open French highway during 3 nocturnal driving sessions. A dose–response design of duration of nocturnal driving was used: a 2 h short driving session (3–5 AM), a 4 h intermediate driving session (1–5 AM) and an 8 h long driving session (9 PM–5 AM).

Participants

Two groups of healthy male drivers (20 for simulated driving and 14 drivers for real driving; mean age ± SD = 22.3 ± 1.6 years), free of sleep disorders.

Measurements

Number of inappropriate line crossings, self-rated fatigue and sleepiness were recorded in the last hour of driving sessions to control the effects of prior waking time and time of day.

Results

Compared to the daytime reference session, both simulated and real driving performance were affected by a short nocturnal driving session (P < .05 and P < .001, respectively). Extension of nocturnal driving duration affected simulated performance nonlinearly and more severely than that of real driving (P < .001).Compared to the daytime reference session, short nocturnal simulated and real driving sessions increased self-perceived fatigue and sleepiness. Real and simulated driving conditions had an identical impact on fatigue and sleepiness during extended periods of nocturnal driving.

Conclusions

In healthy subjects, the INRETS-MSIS SIM2 simulator appropriately measures driving impairment in terms of inappropriate line crossings related to extended wakefulness but has limitations to measure the impact of extended driving on drivers’ performance.     

Not just a rural occurrence: Differences in agricultural equipment crash characteristics by rural–urban crash site and proximity to town

Purpose

Although approximately one-third of agricultural equipment-related crashes occur near town, these crashes are thought to be a rural problem. This analysis examines differences between agricultural equipment-related crashes by their urban–rural distribution and distance from a town.

Methods

Agricultural equipment crashes were collected from nine Midwest Departments of Transportation (2005–2008). Crash zip code was assigned as urban or rural (large, small and isolated) using Rural–Urban Commuting Areas. Crash proximity to a town was estimated with ArcGIS. Multivariable logistic regression was used to estimate the odds of crashing in an urban versus rural zip codes and across rural gradients. ANOVA analysis estimated mean distance (miles) from a crash site to a town.

Findings

Over four years, 4444 crashes involved agricultural equipment. About 30% of crashes occurred in urban zip codes. Urban crashes were more likely to be non-collisions (aOR = 1.69[1.24–2.30]), involve ≥2 vehicles (2 vehicles: aOR = 1.58[1.14–2.20], 3+ vehicles: aOR = 1.68[0.98–2.88]), occur in a town (aOR = 2.06[1.73–2.45]) and within one mile of a town (aOR = 1.65[1.40–1.95]) than rural crashes. The proportion of crashes within a town differed significantly across rural gradients (P < 0.0001). Small rural crashes, compared to isolated rural crashes, were 1.98 (95%CI[1.28–3.06]) times more likely to be non-collisions. The distance from the crash to town differed significantly by the urban-rural distribution (P < 0.0001).

Conclusions

Crashes with agricultural equipment are unexpectedly common in urban areas and near towns and cities. Education among all roadway users, increased visibility of agricultural equipment and the development of complete rural roads are needed to increase road safety and prevent agricultural equipment-related crashes.     

Early morning awakening and nonrestorative sleep are associated with increased minor non-fatal accidents during work and leisure time

Background

The relationship between a composite measure of insomnia and occupational or fatal accidents has been investigated previously; however, little is known regarding the effect of various insomnia symptoms on minor non-fatal accidents during work and leisure time.

Objective

We investigated the predicting role of insomnia symptoms on minor non-fatal accidents during work and leisure time.

Methods

Data from the 2005 Taiwan Social Development Trend Survey of 36,473 Taiwanese aged ≥18 years were analyzed in 2013. Insomnia symptoms, including difficulty in initiating sleep (DIS), difficulty in maintaining sleep (DMS), early morning awakening (EMA), and nonrestorative sleep (NRS) were investigated. A minor non-fatal accident was defined as any mishap such as forgetting to turn off the gas or faucets, accidental falls, and abrasions or cuts occurring during work and leisure time in the past month that do not require immediate medical attention. Multivariable logistic regression was performed to assess the odds ratios (ORs) and associated 95% confidence interval (CI) of minor non-fatal accidents (as a binary variable) for each insomnia symptom compared with those of people presenting no symptoms, while controlling for possible confounders.

Results

EMA and NRS increased the odds of minor non-fatal accidents occurring during work and leisure time (adjusted OR = 1.19, 95% CI = 1.08–1.32 and adjusted OR = 1.27, 95% CI = 1.17–1.37, respectively).

Conclusion

EMA and NRS are two symptoms that are significantly associated with an increased likelihood of minor non-fatal accidents during work and leisure time after adjusting for of a range of covariates.     

US commercial air tour crashes, 2000–2011: Burden,fatal risk factors,and FIA Score validation

Introduction

This study provides new public health data concerning the US commercial air tour industry. Risk factors for fatality in air tour crashes were analyzed to determine the value of the FIA Score in predicting fatal outcomes.

Methods

Using the Federal Aviation Administration's (FAA) General Aviation and Air Taxi Survey and National Transportation Safety Board data, the incidence of commercial air tour crashes from 2000 through 2010 was calculated. Fatality risk factors for crashes occurring from 2000 through 2011 were analyzed using regression methods. The FIA Score, Li and Baker's fatality risk index, was validated using receiver operating characteristic (ROC) curves.

Results

The industry-wide commercial air tour crash rate was 2.7 per 100,000 flight hours. The incidence rates of Part 91 and 135 commercial air tour crashes were 3.4 and 2.3 per 100,000 flight hours, respectively (relative risk [RR] 1.5, 95% confidence interval [CI] 1.1–2.1, P = 0.015). Of the 152 air tour crashes that occurred from 2000 through 2011, 30 (20%) involved at least one fatality and, on average, 3.5 people died per fatal crash. Fatalities were associated with three major risk factors: fire (adjusted odds ratio [AOR] 5.1, 95% CI 1.5–16.7, P = 0.008), instrument meteorological conditions (AOR 5.4, 95% CI 1.1–26.4, P = 0.038), and off-airport location (AOR 7.2, 95% CI 1.6–33.2, P = 0.011). The area under the FIA Score's ROC curve was 0.79 (95% CI 0.71–0.88).

Discussion

Commercial air tour crash rates were high relative to similar commercial aviation operations. Disparities between Part 91 and 135 air tour crash rates reflect regulatory disparities that require FAA action. The FIA Score appeared to be a valid measurement of fatal risk in air tour crashes. The FIA should prioritize interventions that address the three major risk factors identified by this study.     

Fitness-to-drive after mild traumatic brain injury: Mapping the time trajectory of recovery in the acute stages post injury

Introduction

Little is known about the trajectory of recovery in fitness-to-drive after mild traumatic brain injury (mTBI). This means that health-care professionals have limited evidence on which to base recommendations to this cohort about driving.

Objective

To determine fitness-to-drive status of patients with a mTBI at 24 h and two weeks post injury, and to summarise issues reported by this cohort about return to driving.

Method

Quasi-experimental case-control design. Two groups of participants were recruited: patients with a mTBI (n = 60) and a control group with orthopaedic injuries (n = 60). Both groups were assessed at 24 h post injury on assessments of fitness-to-drive. Follow-up occurred at two weeks post injury to establish driver status.

Main Measures

Mini mental state examination, occupational therapy-drive home maze test (OT–DHMT), Road Law Road Craft Test, University of Queensland-Hazard Perception Test, and demographic/interview form collected at 24 h and at two weeks.

Results

At the 24 h assessment, only the OT–DHMT showed a difference in scores between the two groups, with mTBI participants being significantly slower to complete the test (p = 0.01). At the two week follow-up, only 26 of the 60 mTBI participants had returned to driving. Injury severity combined with scores from the 24 h assessment predicted 31% of the variance in time taken to return to driving. Delayed return to driving was reported due to: “not feeling 100% right” (n = 14, 23%), headaches and pain (n = 12, 20%), and dizziness (n = 5, 8%).

Conclusion

This research supports existing guidelines which suggest that patients with a mTBI should not to drive for 24 h; however, further research is required to map factors which facilitate timely return to driving.     

Does wearing helmets reduce motorcycle-related death? A global evaluation

Background

The high risk of injury and death of motorcycle riders is a major global health problem. This study aimed to evaluate the effect of helmet wearing on motorcycle riders’ death rates on a global level.

Methods

Data for motorcycle riders were collected from 70 countries. These data included motorcycle-related death rates per 100 000 population, helmet non-usage percentage, Gross National Income per capita (GNI), number of registered motorized 2–3 wheelers, the effectiveness of law enforcement in each country, and whether there was standards for helmets use or not. Correlations between studied variables were done using Pearson correlation. Multiple linear regression models were used to define factors affecting motorcycle-related death rates.

Results

The correlation between motorcycle-related death rate and helmet non-usage, was almost significant (p = 0.056, r = 0.28). Helmet non-usage percentage was significantly correlated with GNI (p < 0.0001, r = −0.61) and effectiveness of the law (p < 0.0001, r = −0.73). A multiple linear regression model which was highly significant (adjusted R-squared = 0.3, F = 6.69, p < 0.001) has shown that helmet non-usage percentage (p = 0.003), motorcycle per person ratio (p = 0.01) and the presence of helmet standards (p = 0.05) were positively associated with motorcycle-related death rates. A simple linear regression model between helmet usage and road traffic death rate has shown that for each 10% increase in helmet usage, one life per 1 000 000 inhabitants can be saved per year.

Conclusion

Helmet non-usage percentage was the most significant factor affecting motorcyclists’ death rate. Wearing a motorcycle helmet reduces the risk of death from a motorcycle crash. Enforcement of motorcycle helmet laws should be effectively supported by motorcycle safety programs.     

The acute effects of 3,4-methylenedioxymethamphetamine and methamphetamine on driving: A simulator study

Objectives

Illicit drugs such as MDMA and methamphetamine are commonly abused drugs that have also been observed to be prevalent in drivers injured in road accidents. Their exact effect on driving and driving behavior has yet to be thoroughly investigated.

Methods

Sixty-one abstinent recreational users of illicit drugs comprised the participant sample, with 33 females and 28 males, mean age 25.45 years. The three testing sessions involved oral consumption of 100 mg MDMA, 0.42 mg/kg methamphetamine, or a matching placebo. The drug administration was counter-balanced, double-blind, and medically supervised. At each session driving performance was assessed 3 h and 24 h post drug administration on a computerized driving simulator.

Results

At peak concentration overall impairment scores for driving (F_2,118 = 9.042, p < 0.001) and signaling (F_2,118 = 4.060, p = 0.020) were significantly different for the daytime simulations. Performance in the MDMA condition was worse than both the methamphetamine (p = 0.023) and placebo (p < 0.001) conditions and the methamphetamine condition was also observed to be worse in comparison to the placebo (p = 0.055). For signaling adherence, poorer signaling adherence occurred in both the methamphetamine (p = 0.006) and MDMA (p = 0.017) conditions in comparison to placebo in the daytime simulations.

Conclusions

The findings of this study have for the first time illustrated how both MDMA and methamphetamine effect driving performance, and provide support for legislation regarding testing for the presence of illicit drugs in impaired or injured drivers as deterrents for driving under the influence of illicit drugs.     

Urban crash-related child pedestrian injury incidence and characteristics associated with injury severity

Objective

Describe age-based urban pedestrian versus auto crash characteristics and identify crash characteristics associated with injury severity.

Materials and methods

Secondary analysis of the 2004–2010 National Highway and Traffic Safety Administration database for Illinois. All persons in Chicago crashes with age data who were listed as pedestrians (n = 7175 child age ≤19 yo, n = 16,398 adult age ≥20 yo) were included. Incidence and crash characteristics were analyzed by age groups and year. Main outcome measures were incidence, crash setting, and injury severity. Multivariate logistic regression analysis was performed to estimate injury severity by crash characteristics.

Results

Overall incidence was higher for child (146.6 per 100,000) versus adult (117.3 per 100,000) pedestrians but case fatality rate was lower (0.7% for children, 1.7% for adults). Child but not adult pedestrian injury incidence declined over time (trend test p < 0.0001 for <5 yo, 5–9 yo, and 10–14 yo; p < 0.05 for 15–19 yo, p = 0.96 for ≥20 yo). Most crashes for both children and adults took place during optimal driving conditions. Injuries were more frequent during warmer months for younger age groups compared to older (χ²p < 0.001). Midblock crashes increased as age decreased (p < 0.0001 for trend). Most crashes occurred at sites with sub-optimal traffic controls but varied by age (p < 0.0001 for trend). Crashes were more likely to be during daylight on dry roads in clear weather conditions for younger age groups compared to older (χ²p < 0.001). Daylight was associated with less severe injury (child OR 0.93, 95% CI 0.87–0.98; adult OR 0.90, 95% CI 0.87–0.93).

Conclusion

The incidence of urban pedestrian crashes declined over time for child subgroups but not for adults. The setting of pedestrian crashes in Chicago today varies by age but is similar to that seen in other urban locales previously. Injuries for all age groups tend to be less severe during daylight conditions. Age-based prevention efforts may prove beneficial.     

Graduated driver license nighttime compliance in U.S. teen drivers involved in fatal motor vehicle crashes

Background

Examination of teen driver compliance with graduated driver licensing (GDL) laws could be instrumental in identifying factors associated with persistently high motor vehicle mortality rates.

Methods

Fatality analysis reporting system (FARS) data from the years 2006 to 2009 were used in this nation-wide cross-sectional study of drivers covered by a state nighttime GDL law (n = 3492). A new definition of weekend, based on the school night in relation to the teenage social landscape, redefined Friday night as a weekend night and Sunday night as a weekday/school night and compared it to previous weekend definitions. Multiple logistic regression was used to examine independent effects of demographic, behavioral, environmental, contextual, and other factors on compliance with nighttime GDL laws. All analyses were performed in Stata version 11.

Results

Given coverage under nighttime GDL laws, drivers aged 15–17 years were non-compliant in 14.9% of the fatal MVCs in which they were involved, and nearly one-fifth (18.8%) of all fatalities aged 15–17 years were associated with non-compliance. Mortality risk was 10% higher using a revised social (school night) versus traditional (Sat–Sun) weekend definitions. In multivariable analysis, drivers non-compliant with nighttime GDL laws were more likely to be drinking (OR = 4.97, 3.85–6.40), unbelted (OR = 1.58, 1.25–1.99), driving on the weekend (OR = 1.82, 1.47–2.24), and killed (OR = 1.31, 1.04–1.65).

Conclusion

GDL non-compliance contributes to teen motor vehicle mortality. Legislative and enforcement efforts targeting non-school night driving, seatbelt nonuse and alcohol have potential to further reduce teen driving mortality.     

The relationship between excess body weight and the risk of death from unnatural causes

Objective

The purpose is to exam whether excess body weight is associated with an increased risk of death from unnatural causes, particularly, injury.

Method

We analyzed nationally representative data of 14,453 adults (19 and older) who participated in the third National Health and Nutrition Examination Survey, 1988–1994, and were followed up with vital statuses through December 31, 2006. We used Cox proportional hazard regression to estimate the hazard ratio (HR) of death from all unnatural causes combined and specific ones. Gray’s test was performed to assess the equality of cumulative incidence functions between body mass index (BMI) levels.

Results

A total of 128 unnatural deaths were recorded during an 18-year follow-up with 193,019 person-years accumulated. Compared with healthy weight participants, a person with excess body weight had a low hazard of death from unnatural causes [HR = 1.00 (reference), 0.58 (0.39–0.87), and 0.50 (0.30–0.82) for healthy weight, overweight and obese participants, respectively]. Injuries, including motor vehicle accidents and falls, were the major types of unnatural deaths (n = 91, 71% of all unnatural deaths), and the risk of death from injuries was linearly and reversely associated with BMI. The HRs of injury were 1.00 (reference), 0.57 (0.36–0.91), and 0.36 (0.19–0.69) for healthy weight, overweight and obese participants, respectively. All these estimates were obtained after adjustment of socio-demographic variables.

Discussion

Excess body weight appears to be associated with a low risk of death from unnatural causes, particularly, injuries. Additional investigations on the mechanism underlying the relationship between BMI and unnatural deaths are warranted.     

Analgesics and road traffic crashes in senior drivers: An epidemiological review and explorative meta-analysis on opioids

Aim

To assess the epidemiological evidence associating the use of analgesics with the occurrence of road traffic crashes in senior drivers including a meta-analysis with specific focus on opioids.

Methods

Systematic literature review of articles published between 1991 and 2012 retrieved from major databases using relevant key words. Eligible articles were fully reviewed and the main characteristics and results summarized. The methodological quality was assessed using the Newcastle-Ottawa Scale. Heterogeneity tests and forest and funnel plots were used as part of the meta-analysis on opioids.

Results

From the potentially eligible articles, nine were selected (4 case–control, 1 case-crossover, and 4 cohort studies) of which four were of medium and five of high quality; seven investigated opioids and four non-steroidal anti-inflammatory drugs. Crash involvement (n = 7) rather than responsibility (n = 2) was investigated. Age and sex were the most common covariates adjusted for. Both opioids and non-steroidal anti-inflammatory drugs showed mixed results including differences across estimates between and within studies. A marginal positive effect was observed in the pooled analyses on opioids (n = 6, OR 1.20; 95% CI 1.08–1.32).

Conclusions

The evidence is unconvincing in terms of number of studies, control of major confounders, and consistency of the results. The effect seen for opioids can be attributed to the lack of adjustment of key confounders such as concomitant illness or the consumption of alcohol or other psychoactive medications. There is a need for more efficient designs like larger population-based retrospective cohorts and nested case–control or case-crossover studies based on registers of high quality allowing adjustment for these factors and for the selection of unequivocal outcomes (e.g. drivers’ responsibility) to produce more persuasive empirical evidence.     

Cyclists’ clothing and reduced risk of injury in crashes

Introduction

A majority of cyclists’ hospital presentations involve relatively minor soft tissue injuries. This study investigated the role of clothing in reducing the risk of cyclists’ injuries in crashes.

Methods

Adult cyclists were recruited and interviewed through hospital emergency departments in the Australian Capital Territory. This paper focuses on 202 who had crashed in transport related areas. Eligible participants were interviewed and their self-reported injuries corroborated with medical records. The association between clothing worn and injury was examined using logistic regression while controlling for potential confounders of injury.

Results

A high proportion of participants were wearing helmets (89%) and full cover footwear (93%). Fewer wore long sleeved tops (43%), long pants (33%), full cover gloves (14%) or conspicuity aids (34%). The primary cause of injury for the majority of participants (76%) was impact with the ground. Increased likelihood of arm injuries (Adj. OR = 2.06, 95%CI: 1.02–4.18, p = 0.05) and leg injuries (Adj. OR = 3.37, 95%CI: 1.42–7.96, p = 0.01) were associated with wearing short rather than long sleeves and pants. Open footwear was associated with increased risk of foot or ankle injuries (Adj. OR = 6.21, 95%CI: 1.58–23.56, p = 0.01) compared to enclosed shoes. Bare hands were associated with increased likelihood of cuts, lacerations or abrasion injuries (Adj. OR = 4.62, 95%CI: 1.23–17.43, p = 0.02) compared to wearing full cover gloves. There were no significant differences by fabric types such as Lycra/synthetic, natural fiber or leather.

Conclusions

Clothing that fully covers a cyclist’s body substantially reduced the risk of injuries in a crash. Coverage of skin was more important than fabric type. Further work is necessary to determine if targeted campaigns can improve cyclists’ clothing choices and whether impact protection can further reduce injury risk.     

Emergency healthcare worker sleep,fatigue, and alertness behavior survey (SFAB): Development and content validation of a survey tool

Background

Workplace safety is a recognized concern in emergency medical services (EMS). Ambulance crashes are common and injury rates exceed that of the general working public. Fatigue and sleepiness during shift work pose a safety risk for patients and EMS workers. Changing EMS worker behaviors and improving alertness during shift work is hampered by a lack of instruments that reliably and accurately measure multidimensional beliefs and habits that predict alertness behavior.

Objectives

We sought to test the reliability and validity of a survey tool (the sleep, fatigue, and alertness behavior survey [SFAB]) designed to identify the cognitions of EMS workers concerning sleep, fatigue, and alertness behaviors during shift work.

Methods

We operationalized the integrative model of behavioral prediction (IMBP) and developed a pool of 97 candidate items and sub-items to measure eight domains of the IMBP. Five sleep scientists judged the content validity of each item and a convenience sample of EMS workers completed a paper-based version of the SFAB. We retained items judged content valid by five sleep scientists and performed exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and tests of reliability and internal consistency. We identified a simple factor structure for each scale and calculated means and standard deviations for each item and scale.

Results

We received 360 completed SFAB surveys from a convenience sample of 800 EMS workers attending two regional continuing education conferences (45% participation rate). Forty-seven candidate items and sub-items/options were removed following content validation, EFA, and CFA testing. Analyses revealed a simple factor structure for seven of eight domains and a final pool of 50 items and sub-items/options. Domains include: attitudes, normative beliefs, knowledge, salience, habits, environmental constraints, and intent. EFA tests of self-efficacy items failed to identify a simple factor structure. We retained two self-efficacy items based on Spearman–Brown correlation of 0.23 (p < 0.0001).

Conclusions

Measurement of sleep, fatigue, and alertness behavior among EMS workers is challenging. We describe the development and psychometric testing of a survey tool that may be useful in a variety of applications addressing sleep, fatigue, and alertness behavior among EMS workers.     

Fatal crash involvement of unlicensed young drivers: County level differences according to material deprivation and urbanicity in the United States

Objectives

This study assessed the association between county level material deprivation and urbanization with fatal road traffic crashes involving young unlicensed drivers in the United States (US).

Background

Road traffic crashes have been positively associated with area deprivation and low population density but thus far few studies have been concerned specifically with young drivers, especially those that are unlicensed.

Methods

A county material deprivation index was derived from the Townsend Material Deprivation Index, with variables extracted from the US Census (2000). An urbanicity scale was adapted from the US Department of Agriculture's Rural–Urban Continuum Codes (2003). Data on fatal crashes involving a young unlicensed driver during a seven-year period (2000–2006; n = 3059) were extracted from the Fatality Analysis Reporting System. The effect of deprivation and urbanicity on the odds of the occurrence of at least one fatal crash at the county level was modeled by conditional and unconditional logistic regression.

Results

The conditional model found a positive association between material deprivation and a fatal crash involving a young unlicensed driver (OR = 1.19, 95% CI 1.17, 1.21). The interaction between urbanicity and material deprivation was negatively associated in suburban counties for fatal crashes (OR = 0.92, 95% CI 0.90, 0.95).

Conclusions

An association with material deprivation and the likelihood of a fatal crash involving a young unlicensed driver is a new finding. It can be used to inform specific county-level interventions and promote state licensing policies to provide equity in young people's mobility regardless of where they live.     

Association between cannabis use and non-traffic injuries

Background

This study aimed to assess the association between cannabis use and unintended non-fatal injuries other than those caused by road crashes.

Methods

Cross-sectional data were collected from a nationwide sample of 27,934 subjects surveyed in 2005 in Spain: 14,699 persons aged 15–34 years and 13,235 aged 35–64 years. Logistic regression was used to obtain odds ratios (OR) between patterns of cannabis use and frequency of non-traffic injuries, adjusted for sociodemographic factors and for the use of alcohol, tobacco and other drugs.

Results

Cannabis use in the last 12 months was associated with a higher frequency of injuries (OR = 1.4; 95% CI: 1.2–1.7). The OR in older adults (35–64 year age group) was 1.8 and 1.3 in younger people (15–34 year age group). The strongest associations found were between weekly use of cannabis and injuries from knocks and bumps (OR = 5.1; 95% CI 2.9–8.9) and those occurring outside work (OR = 3.0; 95% CI 1.8–4.9) in the older adult population.

Conclusion

Although our analysis did not control for behavioural factors, cannabis use is independently associated with an increased frequency of non-traffic injuries, especially in the older adult population. These associations emphasise the need to carry out longitudinal studies addressing the causal links between cannabis use and unintended injuries.     

Accident rates amongst regular bicycle riders in Tasmania,Australia

Purpose

To characterise the demographics, cycling habits and accident rates of adult cyclists in Tasmania.

Methods

Volunteers ≥18 years of age who had cycled at least once/week over the previous month provided information on demographics; cycling experience; bicycles owned; hours/km/trips cycled per week; cycling purpose; protective equipment used; and major (required third-party medical treatment or resulted ≥1 day off work) or minor (interfered with individuals’ regular daily activities and/or caused financial costs) accidents while cycling.

Results

Over 8-months, 136 cyclists (70.6% male) completed the telephone survey. Mean (standard deviation) age was 45.4 (12.1) years with 17.1 (11.4) years of cycling experience. In the week prior to interview, cyclists averaged 6.6 trips/week (totalling 105.7 km or 5.0 h). The most common reason for cycling was commuting/transport (34% of trips), followed by training/health/fitness (28%). The incidence of major and minor cycling accidents was 1.6 (95% CI 1.1–2.0) and 3.7 (2.3–5.0) per 100,000 km, respectively. Male sex was associated with a significantly lower minor accident risk (incidence rate ratio = 0.34, p = 0.01). Mountain biking was associated with a significantly higher risk of minor accident compared with road or racing, touring, and city or commuting biking (p < 0.05).

Conclusions

Physical activity of regular cyclists’ exceeds the level recommended for maintenance of health and wellbeing; cyclists also contributed substantially to the local economy. Accident rates are higher in this sample than previously reported in Tasmania and internationally. Mountain biking was associated with higher risks of both major and minor accidents compared to road/racing bike riding.     

Knowledge and practice of childhood motor vehicle restraint use in Nova Scotia: Phase II

Objective

To examine changes to knowledge and practice of childhood motor vehicle restraint (CMVR) use in Nova Scotia after the implementation of stricter car seat and new booster seat (BS) legislation in 2007.

Methods

A random telephone survey of households (at least one child <12 years) was performed in 2004 and 2010. Logistic regression determined variables independently associated with correct knowledge and/or practice of CMVR use.

Results

Families were surveyed in the pre- (N = 426 families, 728 children) and post- (N = 453 families, 723 children) legislative periods. Reported appropriate use of forward-facing car seats (FFCSs) and BSs increased significantly (74–92% and 58–95%, respectively). After adjusting for covariates, the post-law period remained a significant predictor of increased knowledge of when to graduate to a BS or a seat belt alone (SB) (OR:1.4(95% CI:1.0–2.0) and 1.9(1.4–2.7), respectively), which was significantly associated with correct use. The strongest independent predictor of the correct use of FFCSs and BSs was the post-law period (OR:14(3.0–68) and 43(17–114), respectively). With regards to rear-facing car seats (RFCSs), new legislation and associated social marketing on graduating from a rear-facing car seat was not associated with increases in correct practice.

Conclusions

Legislation, combined with social marketing at the time of introduction, is an effective means to educate parents on when to graduate from a FFCS and the importance of BSs while also influencing parents to use them, though not for RFCS graduation. The known protective effect of BSs dictates the need for all regions in Canada to adopt comprehensive BS legislation.     

Obstructive sleep apnoea among professional taxi drivers: A pilot study

Purpose

This study aimed to describe the distribution of risk factors for obstructive sleep apnoea syndrome (OSAS) among taxi drivers, and to investigate differences by ethnicity in OSAS symptoms among drivers.

Methods

A two-page postal questionnaire was completed by 241 professional taxi drivers from Wellington, New Zealand. Obstructive sleep apnoea syndrome was defined as having an estimated 15 or more respiratory disturbances, per hour of sleep (Respiratory Disturbance Index (RDI) ≥ 15) and self-reported daytime sleepiness.

Results

Pacific and Māori taxi drivers were more likely to have symptoms and risk factors for OSAS, compared to non-Māori non-Pacific drivers. In particular, Pacific drivers had a significantly increased pre-test probability of having moderate-severe OSA (RDI ≥ 15).

Conclusions

Some professional taxi drivers are at increased risk for moderate-severe OSAS, especially Pacific and Māori taxi drivers. Untreated OSAS increases motor vehicle crash risk, so these findings have implications for the health and safety of drivers and their passengers. They suggest a need for more comprehensive research to guide policy on medical examinations required for licensing professional drivers as fit to drive.