Road traffic injury mortality and morbidity by country development status, 2011-2017 / 中华创伤杂志(英文版)

PURPOSE@#This research examined road traffic injury mortality and morbidity disparities across of country development status, and discussed the possibility of reducing country disparities by various actions to accelerate the pace of achieving Sustainable Development Goals target 3.6 - to halve the number of global deaths and injuries from road traffic accidents by 2020.@*METHODS@#Data for road traffic mortality, morbidity, and socio-demographic index (SDI) were extracted by country from the estimates of the Global Burden of Disease study, and the implementation of the three types of national actions (legislation, prioritized vehicle safety standards, and trauma-related post-crash care service) were extracted from the Global Status Report on Road Safety by World Health Organization. We fitted joinpoint regression analysis to identify and quantify the significant rate changes from 2011 to 2017.@*RESULTS@#Age-adjusted road traffic mortality decreased substantially for all the five SDI categories from 2011 to 2017 (by 7.52%-16.08%). Age-adjusted road traffic mortality decreased significantly as SDI increased in the study time period, while age-adjusted morbidity generally increased as SDI increased. Subgroup analysis by road user yielded similar results, but with two major differences during the study period of 2011 to 2017: (1) pedestrians in the high SDI countries experienced the lowest mortality (1.68-1.90 per 100,000 population) and morbidity (110.45-112.72 per 100,000 population for incidence and 487.48-491.24 per 100,000 population for prevalence), and (2) motor vehicle occupants in the high SDI countries had the lowest mortality (4.07-4.50 per 100,000 population) but the highest morbidity (428.74-467.78 per 100,000 population for incidence and 1025.70-1116.60 per 100,000 population for prevalence). Implementation of the three types of national actions remained nearly unchanged in all five SDI categories from 2011 to 2017 and was consistently stronger in the higher SDI countries than in the lower SDI countries. Lower income nations comprise the heaviest burden of global road traffic injuries and deaths.@*CONCLUSION@#Global road traffic deaths would decrease substantially if the large mortality disparities across country development status were reduced through full implementation of proven national actions including legislation and law enforcement, prioritized vehicle safety standards and trauma-related post-crash care services.

Global road traffic injury statistics: Challenges, mechanisms and solutions / 中华创伤杂志(英文版)

High-quality data are the foundation to monitor the progress and evaluate the effects of road traffic injury prevention measures. Unfortunately, official road traffic injury statistics delivered by governments worldwide, are often believed somewhat unreliable and invalid. We summarized the reported problems concerning the road traffic injury statistics through systematically searching and reviewing the literature. The problems include absence of regular data, under-reporting, low specificity, distorted cause spectrum of road traffic injury, inconsistency, inaccessibility, and delay of data release. We also explored the mechanisms behind the problematic data and proposed the solutions to the addressed challenges for road traffic statistics.

Left-turning vehicle-pedestrian conflicts at signalized intersections with traffic lights: Benefit or harm? A two-stage study / 中华创伤杂志(英文版)

PURPOSE@#Vehicle-pedestrian conflicts are common at road intersections when traffic lights change. However, the impact of traffic light on transportation safety and efficiency remains poorly understood.@*METHODS@#A two-stage study was used to survey the proportion of intersections with conflicting traffic lights and the related transportation efficiency and safety were evaluated as well. First, a cross-sectional study estimated the proportion of signalized intersections with conflicting left-turning vehicle-pedestrian traffic lights in Changsha city, China. Second, a natural experiment compared transportation efficiency and safety between intersections with and without conflicting left-turning vehicle-pedestrian traffic lights. Risky conflicts, where motor vehicles violated laws and failed to yield to pedestrians in crosswalk were used as a surrogate for transportation safety. The number of motor vehicles and pedestrians passing through the intersections per second and per meter were used to estimate transportation efficiency. Data were collected and analyzed in 2015 (from March to December). A search of online news from domestic media sources was also conducted to collect pedestrian injury data occurring at the intersections.@*RESULTS@#About one-fourth (57/216) intersections had conflicting left-turning traffic lights (95% CI: 20.5%, 32.3%). Risky vehicle-pedestrian conflicts were more frequently observed at intersections with conflicting lights compared to those without (incidence rate ratio (IRR) = 3.13; pedestrians: IRR = 4.02), after adjusting for type of day (weekday vs. weekend), the time period of observation, and motor vehicles traffic flow. Intersections without conflicting vehicle-pedestrian traffic lights had similar transportation efficiency to those with conflicting lights after controlling for covariates (p > 0.05). The systematic review of news media reports yielded 10 left-turning vehicle-pedestrian crash events between 2011 and 2017, involving 11 moderate or severe pedestrian injuries and 3 fatal pedestrian injuries.@*CONCLUSION@#Over one-fourth of road intersections in Changsha city, China have conflicting left-turning traffic lights. Conflicting traffic lights cannot improve transportation efficiency, but increase risky conflicts between vehicles and pedestrians.

Gene and environment interaction in familial suicidal behavior: a single family with 4 committed suicides

Family history of suicide is among the strongest predictors of suicide risk. From the context of gene by environment interactions, this manuscript presents a case study of the "M" family, which experienced 4 committed suicides within a short time period. Over the course of 5 years, the father and 3 sons committed suicide. Suicidal ideations developed in several other members of the family. The family's suicide risk appears to have stemmed from both environmental and genetic factors, and likely from an interactive effect between both. Environmental factors included low level of education, opium dependency among male family members, unemployment, and poverty, and limited access to mental health services. Genotype analyses of A218C polymorphism among surviving family members revealed that all individuals were associated with the gene variation [genotypes CC and AC] in tryptophan hydroxylase. The genetic by environmental interaction influence is discussed

Insomnia treatment by Olanzapine. Is sleep state misperception a psychotic disorder?

Offering a new perspective on sleep state misperception, we discuss a patient who presented with sleep state misperception and was ultimately diagnosed with delusional disorder. A 60- year -old woman with chief complaints of insomnia, agitation, and suicidal ideation, was admitted to an inpatient psychiatric ward. Based on information from her family and a mental state examination, her primary diagnosis was sleep state misperception. She was treated with Trazodone. Because she was unresponsive to the treatment, a full psychiatric evaluation and wrist actigraphy report were undertaken, resulting in a revised diagnosis of delusional disorder. She was started on Olanzapine and, after 6 weeks was discharged with good improvement. Sleep state misperception might be considered not just as a sleep disorder, but also as a psychiatric disorder with psychotic symptoms. Further research is recommended

Lifeguard: a forgotten aspect of drowning prevention

An alarming number of drowning occur in lifeguarded swimming areas, where one might presume swimmers are protected from injury. One reason drowning occur in lifeguarded swimming areas is because lifeguard surveillance is a highly difficult task. Observational research suggests lifeguards are usually alert, but researchers also report egregious examples of inattention. We offer three strategies that have initial empirical support to reduce risk of drowning at lifeguarded swimming areas: [a] regular training to help lifeguards recognize they are vulnerable to drowning events and to raise their confidence; [b] regular practice via simulated emergency responses, and [c] addressing staff schedules so lifeguards can devote full attention to protecting swimmer safety while on duty

effects of chronic partial sleep deprivation on cognitive functions of medical residents

Because of on-call responsibilities, many medical residents are subjected to chronic partial sleep deprivation, a form of sleep restriction whereby individuals have chronic patterns of insufficient sleep. It is unclear whether deterioration in cognitive processing skills due to chronic partial sleep deprivation among medical residents would influence educational exposure or patient safety. Twenty-six medical residents were recruited to participate in the study. Participants wore an Actigraph over a period of 5 consecutive days and nights so their sleep pattern could be recorded. Thirteen participants worked on services that forced chronic partial sleep deprivation [<6 hours of sleep per 24h for 5 consecutive days and nights]. The other thirteen residents worked on services that permitted regular and adequate sleep patterns. Following the 5-day sleep monitoring period, the participants completed the three following cognitive tasks: [a] the Wisconsin Card Sorting Test [WCST] to assess abstract reasoning and prefrontal cortex performance; [b] the Time Perception Task [TPT] to assess time estimation and time reproduction skills; and [c] the Iowa Gambling Task [IGT] to assess decision-making ability. The results of independent samples t-tests found no significant differences between the group who was chronically sleep deprived and the group who rested adequately [all ps > .05]. These results may have emerged for several possible reasons: [a] chronic partial sleep deprivation may have a lesser impact on prefrontal cortex function than on other cognitive functions; [b] fairly modest chronic sleep restriction may be less harmful than acute and more significant sleep restriction; or [c] our research may have suffered from poor statistical power. Future research is recommended

Preventing paraffin-related injury

Paraffin [called kerosene in North America and other parts of the world] is the most commonly used fuel in non-electrified dwellings worldwide. It is especially popular in Africa and South Asia. Although paraffin offers many advantages-especially its comparatively low cost to produce- it poses tow major risk of injury. First, paraffin poisoning is common, either through ingestion or through inhalation of smoke and fumes. Second, paraffin is highly flammable, and poses fire risk through multiple causes. This commentary discusses strategies to prevent paraffin-related injury. Prevention of paraffin-related injury must be through multiple strategies, and should include policy-oriented change, changes to the safety of home environments, and behavioral changes targeting how individuals store and use paraffin and paraffin appliances. We review successful prevention strategies in each of these domains and discuss appropriate research and community initiatives that should be implemented to improve paraffin safety among at-risk populations

Personality and injury risk among professional hockey players

Although much is known about risk for athletic injury, research on the roles of individual differences in personality and temperament on athletic injury has lagged. We hypothesized that professional athletes with high sensation-seeking and extraversion scores, and with low effortful control scores, would experience more injuries over the course of a season, would have more severe injuries, and would miss more total days of play. Prospective design with questionnaire report at time one and injury tracking throughout an 18-week athletic season. Professional hockey team in the United States. Eighteen professional hockey players [ages21-33]. Players completed self-report personality [Sensation-Seeking Scale, Form VI and temperament [the Adult Temperament Questionnaire] measures. Quality and severity of injury, as well as playing time missed, were tracked for 18 weeks. On average, players experienced almost 6 injuries causing a loss of 10 playing days through the season. Those players scoring high on Boredom Susceptibility and Total Sensation-Seeking incurred more total injuries. Those Scoring high on temperamental neutral perceptual sensitivity suffered more severe injuries. Athletes who suffered more injuries reported a preference of stimulating environments and boredom with non-stimulating environments. Injury severity was not correlated with sensation-seeking but was related to temperamental perceptual sensitivity. Implications for identification of injury-prone athletes, pre-injury training, and post-injury treatment are discussed