Prévalence et facteurs prédicteurs des troubles post-traumatiques chez les accidentés de la voie publique / Prevalence and predictors of post-traumatic stress disorder in road traffic accidents

Introduction: les troubles post-traumatiques survenant à la suite d'un accident de la route ont un impact tant sanitaire qu'économique. Méthodes: notre étude prospective, vise à déterminer la prévalence de ces troubles, et de dégager leurs facteurs de risque auprès de sujets victimes d'accidents de la route et hospitalisés au service de chirurgie orthopédique et de traumatologie du Centre Hospitalo-Universitaire de Sfax-Tunisie. Résultats: soixante-dix sujets ont été inclus dans notre étude. La prévalence de l'état de stress aigu était de 37,1% et il a été associé au sexe féminin, au niveau scolaire bas, à la présence d'antécédents médicochirurgicaux, à la passivité au cours de l'accident, à la sévérité des lésions, et à la présence d'une symptomatologie anxieuse et dépressive. Le trouble stress post traumatique était constaté chez 40% des sujets et il a été associé au milieu de résidence urbain, à la passivité au cours de l'accident, et à la symptomatologie anxieuse et dépressive. Des scores faibles des stratégies de coping fonctionnelles et des scores élevés des stratégies de coping dysfonctionnelles ont été significativement associés à ces deux troubles. Le niveau scolaire bas, la résidence en milieu urbain, un niveau élevé d'anxiété et de dépression et la stratégie de coping de déni apparaissent comme des facteurs de risque indépendants de l'état de stress aigu et du trouble stress post traumatique. Conclusion: il s'avère ainsi important de déterminer un profil de personnes plus exposées aux troubles post-traumatique afin de permettre un dépistage précoce par les médecins avec lesquels les accidentés pourraient avoir des contacts dans les suites de leurs accidents.

ntroduction: Post-traumatic stress disorder following a road accident has both a health and an economic impact. Methods: we conducted a prospective study to determine the prevalence of this disorder, and to identify risk factors in subjects victims of road accidents and hospitalized in the Department of Orthopedic Surgery and Traumatology of the University Hospital Center of Sfax-Tunisia. Results: a total of sixty-ten subjects were included in this study. The prevalence of acute stress was 37.1% and was associated with female sex, low educational level, previous medical and surgical history, passivity during the accident, severity of injuries and the presence of anxious and depressive symptoms. Post-traumatic stress disorder was observed in 40% of subjects and was associated with urban residential environment, passivity during the accident and anxious and depressive symptoms. Low scores for functional coping strategies and high scores for dysfunctional coping strategies were significantly associated with both disorders. Low educational level, urban residential environment, high levels of anxiety and depression, and denial coping strategy appear to be independent risk factors for acute stress and post-traumatic stress disorder. Conclusion: It is therefore important to determine the profile of people at greater risk of post-traumatic stress disorder, to enable early diagnosis in victims of road accidents.

Referral conditions for severe road traffic injuries and their influence on the occurrence of hospital deaths in Benin

Road traffic accidents are the leading cause of death by trauma. Delays in in first aid due, inter alia, to the long time to transfer traffic accident victims to hospital and the lack of pre-hospital emergency care, contribute to the increase in hospital mortality. This study aims to analyse the referral conditions for severe road traffic injuries and to assess their effect on the occurrence of hospital deaths in Benin. This is an analytical prospective cohort study conducted in road accident victims with a severe injury. Four groups of factors were studied: referral conditions, sociodemographic and victim-specific characteristics, factors related to the accident environment, and factors related to health services. A top-down binary stepwise logistic regression was the basis for the analyses. Nine point eight percent of severe trauma patients died after hospital admission (7.0-13.5). Associated factors were referral time greater than 1 hour (RR=5.7 [1.5-20.9]), transport to hospital by ambulance (RR=4.8 [1.3-17.3]) and by the police or fire department (RR=7.4 [1.8- 29.7]), not wearing protective equipment (RR=4.5 [1.4-15.0]), head injuries (RR=34.8 [8.7-139.6]), and no upper extremity injuries (RR=20.1 [2.3-177.1]). To reduce the risk of hospital death in severe road traffic injuries, it is important to ensure rapid and medicalized referral of severe trauma patients in Benin.

Representaciones sociales de normas de tránsito, agresividad, facilidad percibida en la conducción, accidentes y multas en conductores de Bogotá, D. C. / Social representations of traffic rules, aggressiveness, easiness perceivedin driving, accidents, and traffic tickets involving drivers in Bogota, D. C. / Representações sociais de normas de trânsito, agressividade, facilidadepercebida na condução, acidentes e multas nos motoristas de Bogotá, D. C.

El objetivo principal de este trabajo fue conocer las representaciones sociales sobre normas de tránsito, y su relación con la agresividad y con la accidentalidad, y multas de tránsito autoinformadas en conductores de Bogotá. Se aplicó una encuesta basada en casos (Mamontoff, 2010) con elementosgráficos (Abric, 1993), a una muestra no aleatoriade conductores infractores o en proceso de renovación dela licencia de conducción. Como resultados se identificaron cuatro clases de conductores: dos grupos más dispuestos a consumir alcohol y exceder límites de velocidad (1.ª clase)o no respetar semáforos en rojo y otras señalizaciones (2.ªclase), otro grupo menos de acuerdo con consumir alcohol antes de conducir, pero favorable a superar límites de velocidad(3.ª clase) y otro grupo favorable a no violar ninguna norma de conducción (4.ª clase). Una actitud más favorable a consumir alcohol en la conducción se asoció con atribución de los accidentes a factores externos a los conductores, con haber sido multado más veces en el pasado y con más daños en accidentes. Una mayor agresividad se asoció, asimismo,con una intención de conducta más imprudente.

The main objective in this work consisted of getting to know the social representations about traffic rules and their connection with self-reported aggressiveness, accident rates and fines for traffic offenses by drivers in Bogota. A case-based survey (Mamontoff, 2010) with graphic elements (Abric,1993) was applied to a non-random sample of driving offenders or drivers undergoing their driving license renewal process. As results, four classes of drivers were identified: Two groups more likely to: abuse alcohol and exceed speed limits (1st class), pass through red or yellow lights and disregar dother traffic signs (2nd class); another group that was more cautious about drinking alcohol before driving, but not with regard to exceeding speed limits (3rd class), and another group with a willingness to comply with all driving rules (4th class). A more lenient attitude towards drinking alcohol before or while driving was associated to attributing accidents to factors external to the driver, or with a higher record of fines or sanctions in the past, and having suffered more damages in road-traffic. Likewise, a more far-reaching aggressiveness was associated with an intended less prudent or cautious conduct.

O objetivo principal deste trabalho era conhecer as representações sociais sobre as normas de trânsito, e a sua relação com a agressividade e a acidentalidade, e as multas de trânsito autoinformadas nos motoristas de Bogotá. Uma pesquisa baseada em casos (Mamontoff, 2010) com elementos gráficos (Abric, 1993) foi aplicada a uma amostra não aleatória de motoristas infratores ou em processo da renovação da carteira de motorista. Como resultados identificaram-se quatro classes de motoristas: dois grupos mais prontos para consumir o álcool e exceder limites de velocidade (1°classe)ou não respeitar semáforos em vermelho e outra sinalização(2° classe), um outro grupo menos de acordo com o consumo de álcool antes de dirigir, mas favorável para exceder limites de velocidade (3° classe) e um outro grupo favorável para não infringir nenhuma norma da condução (4° classe). Uma atitude mais favorável para consumir o álcool ao dirigir foi associada com a atribuição dos acidentes aos fatores externos aos motoristas, por ser multado mais vezes no passado e com mais danos nos acidentes. Uma maior agressividade foi associada, também, com uma intenção da conduta mais imprudente.

A Silent Tsunami on Indian Road: A Comprehensive Analysis of Epidemiological Aspects of Road Traffic Accidents.

This paper aims to critically analyze the epidemiology of road traffic accident in India. It is noteworthy to mention that India already accounts for about 9.5% of the total 1.2 million fatal accidents in the world. In 2009, for every 4.14 minute and 1.13 minute one death and one injury took place in India from road accident, respectively. Between 1970 and 2009 the number of accidents has quadrupled (1.1 lakh in 1970 to 4.22 lakh in 2009) with nearly 6.5 fold increase in injuries (0.7 lakh in 1970 to 4.67 lakh in 2009) and nearly 9.5 fold increase in fatalities (0.14 lakh in 1970 to 1.27 lakh in 2009). During the period of 2004 to 2009, road accident rate, injury rate and casualty rate per 105 population have been increased by 8.5%, 4.7% and 29.8%, respectively. In 2009, total 1,08,409 male and 18,487 female died in road accident. It was also observed that in last five years (2005 to 2009) average 84.9% male and 15.1 % female died in road accident. In 2009, total 90,298 people, out of total 1,26,896 accident victims died from age group of (5-44 Yrs), which is the most productive age group for nation. Average percentage share of last five years (2005-2009) for the age groups (Up to 14 Yrs), (15–29 Yrs), (30–44 Yrs), (45–59 Yrs), and (Above 60 Yrs) were 6.35, 29.84, 35.05, 20.97 and 7.79, respectively. The month-wise distribution of ‘Road Accidents’ has also shown more accidents during May (38,928) and June (36,234) sharing 9.2% and 8.6% respectively. Maximum ‘Road Accidents’ (68,835) were reported during 3 p.m. to 6 p.m (16.3%), 64,191 cases during 9 a.m. to 12 noon (15.2%), and least number (28,984) of these accidents (6.9%) was reported during 1200 to 3 AM in the night. The causewise number of persons killed in road accidents indicates that almost three-fourths of the accidents were due to driver’s fault.

A Clinical Study of The Traumatic Amputation By Railroad Accident / 대한정형외과학회잡지

A clinical study of traumatic amputation by railroad accidents was made an 124 patients with 154 amputee, who had been treated at Department of Orthopaedic Surgery, National Seoul Hospital, during the 4 years period from January 1976 to December 1979. The results of this study are as follows: 1. The ratio of male to female was 9 to 1. The 3rd decade of age group showed the hightest number of accident causalties, as much as 37.1%. 2. Causalties showes a maximum during the sprlng (37.1%) and a minimum during winter. 3. The most common injured sites of the amputee were B–K in 44 cases among 154 cases of the amputee. 4. Considering the number of the multiple amputee in 26 casee among 124 cases, frequently they developed in 2 sites with 22 cases, 3 sites with 4 cases. 5. The frequent fracture sites with combined amputation were 18 cases of the pelvic bone, 12 cases of femur in amputation of the lower extremity. 6. Our methods of treatment were debridement, debridement and primary skin closure, debridement with open amputation, circular amputation, closed amputation with skin graft, and closed amputation. 7. The major complications were phantom limb in 108 cases (70.1%), infection in 44 cases (28.6%). 8. The most frequent infectious agent was pseudomonas (16 cases).