Increase in Motor Vehicle Crash Severity: An Unforeseen Consequence of COVID-19.

INTRODUCTION: The 2019 coronavirus (COVID-19) pandemic led to stay-at-home (SAH) orders in Pennsylvania targeted at reducing viral transmission. Limitations in population mobility under SAH have been associated with decreased motor vehicle collisions (MVC) and related injuries, but the impact of these measures on severity of injury remains unknown. The goal of this study is to measure the incidence, severity, and outcomes of MVC-related injuries associated with SAH in Pennsylvania. MATERIALS & METHODS: We conducted a retrospective geospatial analysis of MVCs during the early COVID-19 pandemic using a state-wide trauma registry. We compared characteristics of patients with MVC-related injuries admitted to Pennsylvania trauma centers during SAH measures (March 21-July 31, 2020) with those from the corresponding periods in 2018 and 2019. We also compared incidence of MVCs for each zip code tabulation area (ZCTA) in Pennsylvania for the same time periods using geospatial mapping. RESULTS: Of 15,550 trauma patients treated during the SAH measures, 3486 (22.4%) resulted from MVCs. Compared to preceding years, MVC incidence decreased 10% under SAH measures with no change in mortality rate. However, in ZCTA where MVC incidence decreased, there was a 16% increase in MVC injury severity. CONCLUSIONS: Stay-at-home orders issued in response to the COVID-19 pandemic in Pennsylvania were associated with significant changes in MVC incidence and severity. Identifying such changes may inform resource allocation decisions during future pandemics or SAH events.

A decomposition of the effects of the COVID-19 pandemic on changes in the motor vehicle collision related mortality in Alabama.

BACKGROUND/OBJECTIVE: Motor vehicle collisions are the leading cause of unintentional injury death in Alabama and at various points during the COVID-19 pandemic there were documented increases in the following risk driving behaviors: speeding, driving under the influence, and seat belt citations. Thus, the objective was to characterize the overall motor vehicle collision (MVC)-related mortality rate in Alabama and the contribution of each component over the first two years of the pandemic compared to before the pandemic by three different road classes: urban arterials, rural arterials, and all other road classes. METHODS: MVC data were derived from the Alabama eCrash database, an electronic crash reporting system used by police officers across the state. Data on vehicle miles traveled each year were collected from the U.S. Department of Transportation's Federal Highway Administration estimates of traffic volume trends. MVC-related mortality in Alabama was the primary outcome and year of MVC was the exposure. The novel decomposition method broke down population mortality rate into four parts: deaths per MVC injury, injury per MVC, MVC per vehicle miles traveled (VMT), and VMT per population. Poisson models with scaled deviance were used to estimate rate ratios of each component. Relative contribution (RC) of each component was calculated by taking the absolute value of the component's beta coefficient and dividing by the sum of the absolute values of all components' beta coefficients. Models were stratified by road class. RESULTS: Across all road classes combined, there were no significant changes to the overall MVC-related mortality rate (per population) and its components when comparing 2020-2022 to 2017-2019; this was due to the increased case fatality rate (CFR) being offset by decreases in the VMT rate and MVC injury rate. In 2020, among rural arterials a non-significant increased mortality rate was offset by a decreased VMT rate (RR 0.91, 95% CI 0.84-0.98, RC 19.2%) and MVC injury rate (RR: 0.89, 95% CI: 0.82-0.97, RC: 22.2%) when compared to 2017-2019. For non-arterials, a non-significant decreased MVC mortality rate was observed in 2020 when compared to 2017-2019 (RR 0.86, 95% CI 0.71-1.03). When considering 2021-2022 versus 2020, the only significant component for any road class was a decreased MVC injury rate for non-arterials (RR: 0.90,95% CI: 0.89-0.93) but this was offset by an increased MVC rate and CFR, resulting in no significant change to the mortality rate (per population). CONCLUSIONS: In a state with one of the highest MVC-related mortality rates in the country, despite decreases in VMTs per population and injuries per MVC, the MVC mortality rate per population did not change during the pandemic due in part to the contributions of an increase in the case fatality rate. Future research should determine whether the increase in CFR was associated with risky driving behaviors during the pandemic.

The French automotive industry faces the challenge of the ecological transition

[...]the vehicle of the future must be considered within the broader framework of the mobility of the future, taking into account the entire value chain. Transforming our future into a sustainable future: planning for the automotive transition Didier Sepulchre de Condé, Mechanical industry The automotive industry is in turmoil, firstly because of the economic situation, with a market deeply affected by Covid, shortages of materials and components and disoriented customers;and secondly because of the structural situation, with the forced transition to electrification. The four paradoxes of the ecological transition of the European car industry Alois Kirchner, Former Director of Cabinet of the Minister for Industry The energy transition in the automotive sector is essential for achieving French and European climate objectives. [...]the actions implemented come up against four paradoxes, which must be overcome if this transition is to succeed: * the regulation on the reduction of CO2 emissions from the tank to the wheel, to the exclusion of other sources which now represent the majority of emissions from new vehicles;* the steering of vehicle traffic restrictions based on Crit'air stickers, leading to the prohibition of access to certain cities for vehicles that are more virtuous than others that are still allowed to enter;* the inability to implement policies to support the production of vehicles on European soil that are sufficiently powerful to halt the fall in associated jobs;a situation that benefits production sites that are not subject to the same environmental standards;* and the rising price of "green" vehicles, leading to a slowdown in the renewal of the fleet and the maintenance of a high level of pollution and carbon emissions.

Increase in traumatic injury burden amidst COVID-19 was disproportionately shouldered by racial and ethnic minority patients: An urban case study

Background: When the COVID-19 pandemic intersected with the longstanding global pandemic of traumatic injury, it exacerbated racial and ethnic disparities in injury burden. As Milwaukee, Wisconsin is a racially diverse yet segregated urban city due to historic and ongoing systemic efforts, this populace provided an opportunity to further characterize injury disparities. Method(s): We analyzed trauma registry data from the only adult Level 1 trauma center in Milwaukee, WI before and during the COVID-19 pandemic (N = 19,908 patients from 2015-2021). We retrospectively fit seasonal ARIMA models to monthly injury counts to determine baseline injury burden pre-COVID-19 (Jan 2015-Mar 2020). This baseline data was used to forecast injury by race and ethnicity from April 2020 to December 2021 and was compared to actual injury counts. Result(s): For all mechanisms of injury (MOI), counts during the pandemic were significantly higher than forecasted for Black or African American (mean absolute percentage error, MAPE = 23.17) and Hispanic or Latino (MAPE = 26.67) but not White patients (MAPE = 12.72). Increased injury for Black or African American patients was driven by increases in motor vehicle crashes (MVCs) and firearm-related injury;increased injury for Hispanic or Latino patients was driven by falls and MVCs. Conclusion(s): The exacerbation of injury burden disparities during COVID-19, particularly in specific MOI, underscores the need for primary injury prevention within specific overburdened communities. Injury prevention requires intervention through social determinants of health, including addressing the impact of structural racism, as primary drivers of injury burden disparities.Copyright © The Author(s) 2023.

Changes of Air Pollutants in Urban Cities during the COVID-19 Lockdown-Sri Lanka

In response to the COVID-19 pandemic in early 2020, Sri Lanka underwent a nationwide lockdown that limited motor vehicle movement, industrial operations, and human activities. This study analyzes the impact of COVID-19 lockdown on carbon monoxide (CO), ozone (O3), nitrogen dioxide (NO2), sulfur dioxide (SO2), and particulate matter (PM10, PM2.5) concentrations in two urban cities (Colombo and Kandy) in Sri Lanka, by comparison of data from the lockdown period (March to May 2020) with its analogous period of 2019 and 2021. The results showed that the percentage change of daytime PM10, PM2.5, CO, and NO2 concentration during the lockdown in Colombo (Kandy) is –42.3% (–39.5%), –46% (–54.2%), –14.7% (–8.8%) and –82.2% (–80.9%), respectively. In both cities, the response of NO2 to the lockdown was the most sensitive. In contrast, daytime O3 concentration in Colombo (Kandy) has increased by 6.7% (27.2%), suggesting that the increase in O3 concentration was mainly due to a reduction in NOx emissions leading to lower O3 titration by NO. In addition, daytime SO2 concentration in Colombo has increased by 22.9%, while daytime SO2 concentration in Kandy has decreased by –40%. During the lockdown period, human activities were significantly reduced, causing significant reductions in industrial operations and transportation activities, further reducing emissions and improving air quality in two cities. The results of this study offer potential for local authorities to better understand the emission sources, assess the effectiveness of current air pollution control strategies, and form a basis for formulating better environmental policies to improve air quality and human health. © The Author(s).

The effects of tie strength and data integration with supply base on supply disruption ambiguity and its impact on inventory turnover

PurposeIn this paper, the authors introduce supply disruption ambiguity as the inability of a sourcing firm to attach probability point estimates to the occurrence of and to the magnitude of loss from supply disruptions. The authors drew on the "ambiguity in decision-making” literature to define this concept formally, connected it to relevant supply disruption information deficit, positioned it relative to supply chain risk assessment and hypothesized and tested its negative associations with both supply base ties and inventory turnover.Design/methodology/approachThe authors analysed survey data from 171 North American manufacturers and archival data for a subset (88 publicly listed) of these manufacturers via Ordinary Least Squares (OLS) estimation after ensuring that methodological concerns with survey research have been addressed. They used appropriate controls and employed the heteroskedasticity-based instrumental variable (HBIV) approach to ensure that inferences from our results are not unduly influenced by endogeneity.FindingsStrong supply base ties decrease supply disruption ambiguity, which, in turn, increases inventory turnover. Moreover, strong supply base ties and data integration with the supply base have indirect and positive effects on inventory turnover. As sourcing firms strengthen ties and integrate data exchange with their supply base, their inventory turnover improves from access to information relevant to detect and diagnose supply disruptions effectively.Originality/valueResearch on supply disruption management has paid more attention to the "disruption recovery” stage than to the "disruption discovery” stage. In this paper, the authors add novel insights regarding the recognition and diagnosis aspects of the "disruption discovery” stage. These novel insights reveal how and why sourcing firms reduce their overall ambiguity associated with detecting and assessing losses from supply disruptions through establishing strong ties with their supply base and how and why reducing such ambiguity improves inventory turnover performance.

Strategic Planning and Economic Recovery in the Post-Pandemic of the Automotive Sector

This research analyzes from three indicators the impact suffered by the automotive sector in Ecuador after the pandemic and proposes a generic model for the design and creation of strategic planning that helps companies in the sector to adapt to the new context and reactivate their activities in the face of new consumption habits,o maintain its validity in the market. The methodology used was quantitative, the method was deductive of explanatory scope with a non-experimental cross-sectional design, since historical documentary sources published by the Association of Automotive Companies of Ecuador (AEADE) were used. According to the results obtained with this study, it was determined that in 2022, after the pandemic, there was an increase in the number of imported vehicles, a decrease in the number of vehicles sold that were assembled in the country, and there is no significant difference in the number of imported vehicles marketed in the country. In any of these cases, the implementation or updating of appropriate strategic planning in organizations that develop activities in the automotive field will allow the best performance of these and their greater validity in the market. Given these effects, the Government needs to support policies for the preservation of capacities and resources, as well as their subsequent strengthening to promote post-pandemic recovery. The model proposed as a product of the study is composed of 9 phases that allow to develop and apply strategic planning in companies in the automotive sector, this model arises from the review and adoption of the best practices found in four of the most used modelsto the global novel.Copyright © 2023, Anka Publishers. All rights reserved.

Digital Government in Application-Based Motor Vehicle Tax Payments in Indonesia

Amid the current pandemic, information technology such as the internet has become a basic need for society. The increasingly limited space for movement requires people to master technology to be able to survive and interact virtually. On the other hand, technology that has become a basic need also needs to be adopted by the government to improve public services amidst the COVID-19 pandemic to be more effective and efficient. E-Government and digital government in Indonesia are strengthened by the presence of Presidential Instruction No. 3 of 2003, as well as Presidential Regulation (Perpres) no. 95 of 2018 concerning the Electronic-Based Government System (SPBE). One of these acceleration efforts is also strengthened by the presence of the electronic-based government system index (SPBE) which measures how the electronic-based government system in Indonesia is at the regional level. As people increasingly master technology, the form of technology-based services (e-services) will be increasingly needed by the public. So, how does the government respond to this? West Java Province itself through Bapenda (Regional Revenue Agency) and a team of IT experts has launched an application called Sambara (West Java Mobile Samsat), a public service in the form of an Android-based smartphone application for payment of Motor Vehicle Tax (PKB) in West Java Province. The application is also implemented in Banten Province through the SAMBAT (Samsat Banten Hebat) and SIGNAL (National Digital Samsat) Applications as well as Cooperation in the Management of Regional Levies through the SIREDA (Regional Retribution System) application.Copyright © 2023, Anka Publishers. All rights reserved.

Content posted by Spanish automotive sector brands on YouTube: branded content, insights and environmental commitment

PurposeThe main objective of this study is to analyze content posted by automotive sector brands on their YouTube channels, identifying the use of a branded content format, the application of insights to creative conceptualization and the dissemination of messages related to messages' environmental commitment.Design/methodology/approachA descriptive study was conducted using qualitative content analysis as the methodological approach. The sample is made up of 691 videos posted on YouTube from September 2020 to August 2021 by the ten automotive brands with the biggest advertising budgets in Spain (InfoAdex, 2021).FindingsThe findings reveal a predominance of the advertorial format in content posted on YouTube by automotive sector brands, while the branded content format is less popular. Creative concepts based on insights are rare and limited to videos with an advertisement format. The theme of respect for the environment is used mainly in connection with the discourse on vehicle features and not so much as a commitment by the brand in response to consumer concerns or the changes that the automotive sector is undergoing.Originality/valueThe originality of the study lies in the approach it takes to content posted by automotive brands on YouTube. The paper's contribution is innovative in that the study monitors posts by brands in the sample on YouTube over the course of a year, rather than just during the specific periods when these brands run advertising campaigns.

Covid-Döneminde ve Öncesinde Firmaların Finansal Performanslarının CRITIC Temelli CoCoSo Yöntemi ile Analizi, BÍST Otomotiv Sektörü Üzerine Bir Uygulama

Covid-19 pandemisinin tüm dünyaya yayılması sonucunda tüm sektörler ekonomik olarak bu krizden etkilenmiştir. Bu krizden etkilen önemli sektörlerden birisi de otomotiv sektörü olmuştur. Küresel ekonominin %4'ünü oluşturan otomotiv sektörü bu süreçte birçok sorunla mücadele etmek durumunda kalmıştır. Bu bağlamda bu çalışma Covid-19 döneminde (2020-2021) ve öncesinde (2018-2019) BÍST'te faaliyet gösteren otomotiv firmalarının finansal performanslarını analiz etmeyi amaçlamıştır. Bu noktadan hareketle firmaların finansal performanslarını analiz etmede çok kriterli karar verme yöntemlerinden birisi olan CRITIC tabanlı CoCoSo yöntemi kullanılmıştır. CRITIC yöntemiyle yapılan analiz sonucunda en fazla önem ağırlığına sahip kriter, özsermaye devir hızı rasyosu olurken;en az önem ağırlığına sahip kriter ise ekonomik rantabilite rasyosu olmuştur. CoCoSo yöntemiyle yapılan analiz sonucunda ise finansal performans sıralamasında FMÍZP ve FROTO firmaları ilk iki sırayı alırken KATMR ve BALAT firmaları ise son sıralarda yer almışlardır. Pandeminin etkisiyle elde edilen analiz sonuçları birlikte incelendiğinde pandemi öncesi dönemle pandemi döneminde finansal performans sıralamasında genel olarak bir değişiklik olmadığı, pandeminin firmaların finansal performans sıralamalarını değiştirmediği görülmektedir.Alternate : As a result of the spread of the Covid-19 pandemic worldwide, all sectors have been economically affected by this crisis. One of these sectors is automotive sector. The automotive sector, which constitutes 4% of the global economy, had to struggle with many problems in this process. In this context, this study aimed to analyse the financial performances of automotive companies operating in the BIST during the Covid-19 period (2020-2021) and before (2018-2019). From this point of view, the CRITIC-based COCOSO method, one of the multi-criteria decision-making methods, was used to analyse the financial performance of companies. As a result of the analysis conducted by the CRITIC method, the most important criterion was the equity turnover ratio. The criterion with the least important was the economic profitability ratio. As a result of the analysis made with the CoCoSo method, FMÍZP and FROTO companies took the first two places in the financial performance ranking, while KATMR and BALAT companies took the last place. When the analysis results obtained with the effect of the pandemic are examined together, it is seen that there was no general change in the financial performance rankings between the pre-pandemic period and the pandemic period, and the pandemic did not change the financial performance rankings of the companies.

COVID-19 Pandemic: Impacts on Air Quality during Partial Lockdown in the Metropolitan Area of São Paulo

Air pollution has become one of the factors that most affect the quality of life, human health, and the environment. Gaseous pollutants from motor vehicles have a significantly harmful effect on air quality in the Metropolitan Area of São Paulo (MASP)—Brazil. Motor vehicles emit large amounts of particulate matter (PM), carbon monoxide (CO), nitrogen oxides (NOx), and volatile organic compounds (VOCs), the last three acting as the main tropospheric ozone (O3) precursors. In this study, we evaluated the effects of these pollutants on air quality in the MASP during the partial lockdown that was imposed to ensure the social distancing necessitated by the COVID-19 pandemic. We compared the monthly data for nitrogen dioxide (NO2) from the Ozone Monitoring Instrument (OMI) and CO, SO2, and BC from MERRA-2 for the period between April and May 2020 (during the pandemic) with the average for the same period for the (pre-pandemic) years 2017 to 2019 in the southeast region of Brazil. The meteorological and pollutant concentration data from the CETESB air quality monitoring stations for the MASP were compared with the diurnal cycle of three previous years, with regard to the monthly averages of April and May (2017, 2018, and 2019) and the same period in 2020, when the partial lockdown was first imposed in southeast Brazil. Our findings showed that there was a decrease in NO2 concentrations ranging from 10% to more than 60% in the MASP and the Metropolitan Area of Rio de Janeiro (MARJ), whereas in the Metropolitan Area of Belo Horizonte and Vitoria (MABH and MAV, respectively), there was a reduction of around 10%. In the case of the concentrations of CO and BC from MERRA-2, there was a considerable decrease (approx. 10%) during the period of partial lockdown caused by COVID-19 throughout almost the entire state of São Paulo, particularly in the region bordering the state of Rio de Janeiro. The concentration of SO2 from MERRA-2 was 5 to 10% lower in the MASP and MARJ and the west of the MABH, and there was a decrease of 30 to 50% on the border between the states of São Paulo and Rio de Janeiro, while in the MAV region, there was an increase in pollutant levels, as this region was not significantly affected by the COVID-19 pandemic. Sharp reductions in the average hourly concentrations of CO (38.8%), NO (44.9%), NO2 (38.7%), and PM2.5 (6%) were noted at the CETESB air quality monitoring stations in the MASP during the partial lockdown in 2020 compared with the hourly average rate in the pre-pandemic period. In contrast, there was an increase of approximately 16.0% in O3 concentrations in urban areas that are seriously affected by vehicular emissions, which is probably related to a decrease in NOx. © 2023 by the authors.

Pedestrian Deaths During the COVID-19 Pandemic.

The COVID pandemic provides a natural experiment examining how a 50-60% reduction in pedestrian activity might lead to a reduction in pedestrian deaths. We assessed whether the reduction in pedestrian deaths was proportional to a one-to-one matching presumed in statistics correlating mobility with fatality. The primary analysis examined New York (largest city in US), and the validation analysis examined Toronto (largest city in Canada). We identified pedestrian activity in each location from the Apple Mobility database, normalized to the baseline in January 2020. We calculated monthly pedestrian deaths from the Vision Zero database in each city with baseline data from 3 prior years. We found a large initial reduction in pedestrian deaths during the lockdown in New York that was transient and not statistically significant during the summer and autumn despite sustained reductions in pedestrian activity. Similarly, we found a large initial reduction in pedestrian deaths during the lockdown in Toronto that was transient and not sustained. Together, these data suggest the substantial reductions in pedestrian activity during the COVID pandemic have no simple correlation with pedestrian fatality counts in the same locations. An awareness of this finding emphasizes the role of unmeasured modifiable individual factors beyond pedestrian infrastructure or other structural contributors.

The effect of recreational cannabis legalization on rates of traffic injury in Canada.

AIMS: To measure the impact of Canada's recreational cannabis legalization (RCL) in October 2018 and the subsequent impact of the coronavirus disease 2019 (COVID-19) lockdowns from March 2020 on rates of emergency department (ED) visits and hospitalizations for traffic injury. DESIGN: An interrupted time series analysis of rates of ED visits and hospitalizations in Canada recorded in population-based databases from January/April 2010 to March 2021. SETTING: ED visits in Ontario and Alberta and hospitalizations in Ontario, Alberta, British Columbia, the Prairies (Manitoba and Saskatchewan) and the Maritimes (Nova Scotia, New Brunswick, Newfoundland and Prince Edward Island). PARTICIPANTS: Monthly counts of presentations to the ED or hospital for motor vehicle injury or pedestrian/cyclist injury, used to calculate monthly rates per 100 000 population. MEASUREMENTS: An occurrence of one or more International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Canada (ICD-10-CA) code for motor vehicle injury (V20-V29, V40-V79, V30-V39 and V86) and pedestrian/cyclist injury (V01-V09 and V10-V19) within the National Ambulatory Care Reporting System and Discharge Abstract Database. FINDINGS: There were no statistically significant changes in rates of ED visits and hospitalizations for motor vehicle or pedestrian/cyclist injury after RCL after accounting for multiple testing. After COVID-19, there was an immediate decrease in the rate of ED visits for motor vehicle injury that was statistically significant only in Ontario (level change ß = -16.07 in Ontario, 95% CI = -20.55 to -11.60, P = 0.000; ß = -10.34 in Alberta, 95% CI = -17.80 to -2.89, P = 0.008; α of 0.004) and no changes in rates of hospitalizations. CONCLUSIONS: Canada's recreational cannabis legalization did not notably impact motor vehicle and pedestrian/cyclist injury. The rate of emergency department visits for motor vehicle injury decreased immediately after COVID-19 lockdowns, resulting in rates below post-recreational cannabis legalization levels in the year after COVID-19.

[The proximal femur fracture epidemic continued during the COVID-19 pandemic: results of an observational study]. / L'épidémie de fractures de l'extrémité proximale du fémur n'a pas diminuée pendant la pandémie COVID-19: résultats d'une étude observationnelle.

INTRODUCTION: The aim of this study was to compare the volume and characteristics of emergency trauma surgery procedures done at our hospital between March 20 and April 20, 2020 (the first month of the national lockdown in France) and to compare these data to the same period in 2019. We hypothesized that a portion of fractures are unavoidable, thus specific preventative measures will be needed to reduce their incidence. METHODS: This was a continuous, observational, single center study. All patients who required urgent surgery for a fracture between March 20 and April 20, 2020, were included. Data for the same period in 2019 was retrieved. All the procedures were done at our hospital, which is a regional level II trauma center. RESULTS: During the first month of the lockdown, 70 patients underwent emergency surgery because of a fracture, versus 109 patients in the same period in 2019, thus an overall 36% drop. The mean age of the patients was higher in 2020 (68.4 years SD = 22) than in 2019 (60.3 years SD = 24, p = 0.0210). There were fewer recreational and motor vehicle accidents in 2020 (34 vs. 10) and fewer work-related accidents (7 vs. 2) although the number of accidents at home were similar (65 vs. 55). CONCLUSION: During a public health emergency, it is vital to continue doing trauma surgery procedures, even though it requires a specific care pathway. The lockdown and associated behavioral changes have altered the spectrum of trauma surgery. A major decrease in motor vehicle, recreation and work-related accidents is the avoidable portion of this surgical activity, justifying specific preventative measures during a public health crisis. Conversely, the incidence of geriatric fractures - particularly of the proximal femur - did not change much overall, thus there is need for additional preventative measures in these patients. LEVEL OF EVIDENCE: V, observational study.

The proximal femur fracture epidemic continued during the COVID-19 pandemic: Results of an observational study.

INTRODUCTION: The aim of this study was to compare the volume and characteristics of emergency trauma surgery procedures done at our hospital between March 20 and April 20, 2020 (the first month of the national lockdown in France) and to compare these data to the same period in 2019. We hypothesized that a portion of fractures are unavoidable, thus specific preventative measures will be needed to reduce their incidence. METHODS: This was a continuous, observational and single center study. All patients who required urgent surgery for a fracture between March 20 and April 20, 2020, were included. Data for the same period in 2019 was retrieved. All the procedures were done at our hospital, which is a regional level II trauma center. RESULTS: During the first month of the lockdown, 70 patients underwent emergency surgery because of a fracture, versus 109 patients in the same period in 2019, thus an overall 36% drop. The mean age of the patients was higher in 2020 (68.4 years SD=22) than in 2019 (60.3 years SD=24, p=0.0210). There were fewer recreational and motor vehicle accidents in 2020 (34 vs. 10) and fewer work-related accidents (7 vs. 2) although the number of accidents at home were similar (65 vs. 55). CONCLUSION: During a public health emergency, it is vital to continue doing trauma surgery procedures, even though it requires a specific care pathway. The lockdown and associated behavioral changes have altered the spectrum of trauma surgery. A major decrease in motor vehicle, recreation and work-related accidents is the avoidable portion of this surgical activity, justifying specific preventative measures during a public health crisis. Conversely, the incidence of geriatric fractures - particularly of the proximal femur - did not change much overall, thus there is need for additional preventative measures in these patients. LEVEL OF EVIDENCE: V, observational study.

COVID Vaccine Hesitancy and Risk of a Traffic Crash.

BACKGROUND: Coronavirus disease (COVID) vaccine hesitancy is a reflection of psychology that might also contribute to traffic safety. We tested whether COVID vaccination was associated with the risks of a traffic crash. METHODS: We conducted a population-based longitudinal cohort analysis of adults and determined COVID vaccination status through linkages to individual electronic medical records. Traffic crashes requiring emergency medical care were subsequently identified by multicenter outcome ascertainment of all hospitals in the region over a 1-month follow-up interval (178 separate centers). RESULTS: A total of 11,270,763 individuals were included, of whom 16% had not received a COVID vaccine and 84% had received a COVID vaccine. The cohort accounted for 6682 traffic crashes during follow-up. Unvaccinated individuals accounted for 1682 traffic crashes (25%), equal to a 72% increased relative risk compared with those vaccinated (95% confidence interval, 63-82; P < 0.001). The increased traffic risks among unvaccinated individuals extended to diverse subgroups, was similar to the relative risk associated with sleep apnea, and was equal to a 48% increase after adjustment for age, sex, home location, socioeconomic status, and medical diagnoses (95% confidence interval, 40-57; P < 0.001). The increased risks extended across the spectrum of crash severity, appeared similar for Pfizer, Moderna, or other vaccines, and were validated in supplementary analyses of crossover cases, propensity scores, and additional controls. CONCLUSIONS: These data suggest that COVID vaccine hesitancy is associated with significant increased risks of a traffic crash. An awareness of these risks might help to encourage more COVID vaccination.

The Impact of Urban Facilities on Crime during the Pre- and Pandemic Periods: A Practical Study in Beijing.

The measures in the fight against COVID-19 have reshaped the functions of urban facilities, which might cause the associated crimes to vary with the occurrence of the pandemic. This paper aimed to study this phenomenon by conducting quantitative research. By treating the area under the jurisdiction of the police station (AJPS) as spatial units, the residential burglary and non-motor vehicle theft that occurred during the first-level response to the public health emergencies (pandemic) period in 2020 and the corresponding temporal window (pre-pandemic) in 2019 were collected and a practical study to Beijing was made. The impact of urban facilities on crimes during both periods was analyzed independently by using negative binomial regression (NBR) and geographical weight regression (GWR). The findings demonstrated that during the pandemic period, a reduction in the count and spatial concentration of both property crimes were observed, and the impact of facilities on crime changed. Some facilities lost their impact on crime during the pandemic period, while other facilities played a significant role in generating crime. Additionally, the variables that always kept a stable significant impact on crime during the pre- and pandemic periods demonstrated a heterogeneous impact in space and experienced some variations across the periods. The study proved that the strategies in the fight against COVID-19 changed the impact of urban facilities on crime occurrence, which deeply reshaped the crime patterns.

Substance use in rural trauma patients admitted for motor vehicle injuries before and during the COVID-19 pandemic.

BACKGROUND: Urban trauma centers reported increased substance use among individuals injured in motor vehicle collisions (MVC) after the start of the COVID-19 pandemic. Little is known about individuals admitted to rural trauma centers during this time. This study's purpose was to describe substance use trends before and during the pandemic among individuals injured in MVC and treated at a rural Level-1 trauma center in West Virginia. METHODS: A cross-sectional analysis was performed using patients' medical records. The study population included individuals ≥ 18 years of age who received treatment for a motor vehicle-related injury between September 1, 2018, and September 30, 2021, and were tested for drugs and alcohol upon admittance. The pre-COVID-19 period was defined as September 1, 2018-March 15, 2020. The COVID-19 period was March 16, 2020-September 30, 2021. The primary dependent variable was the patients' drug test results. The primary independent variable was the time period. The data were analyzed using Chi-square tests, logistic regression, and proportional odds models. RESULTS: During this time, 1465 patients received treatment. On average, patients were 45 years ± 20 of age and male (57%). During COVID-19, 17% of patients tested positive for alcohol and 58% tested positive for non-alcohol drugs. After adjusting for patients' sex and age, the number of drugs that patients tested positive for was 31% higher during COVID-19 (aOR 1.31; 95% CI 1.08, 1.58). The proportion of patients testing positive for cannabinoids (p = 0.05), opioids (p = 0.001), and stimulants (p = 0.010) increased from pre-COVID-19 to COVID-19 periods. CONCLUSIONS: Drug and alcohol use increased among trauma patients admitted to a rural trauma center during COVID-19. Significant increases were seen in the number of drugs and for cannabinoids, opioids, and stimulants.

Impact of easing COVID-19 lockdown restrictions on traumatic injuries in Riyadh, Saudi Arabia: one-year experience at a major trauma centre.

INTRODUCTION: Lockdown restrictions due to the COVID-19 pandemic have reduced the number of injuries recorded. However, little is known about the impact of easing COVID-19 lockdown restrictions on the nature and outcome of injuries. This study aims to compare injury patterns prior to and after the easing of COVID-19 lockdown restrictions in Saudi Arabia. METHOD: Data were collected retrospectively from the Saudi TraumA Registry for the period between March 25, 2019, and June 21, 2021. These data corresponded to three periods: March 2019-February 2020 (pre-restrictions, period 1), March 2020-June 2020 (lockdown, period 2), and July 2020-June 2021 (post easing of restrictions, period 3). Data related to patients' demographics, mechanism and severity of injury, and in-hospital mortality were collected and analysed. RESULTS: A total of 5,147 traumatic injury patients were included in the analysis (pre-restrictions n = 2593; lockdown n = 218; post easing of lockdown restrictions n = 2336). An increase in trauma cases (by 7.6%) was seen in the 30-44 age group after easing restrictions (n = 648 vs. 762, p < 0.01). Motor vehicle crashes (MVC) were the leading cause of injury, followed by falls in all the three periods. MVC-related injuries decreased by 3.1% (n = 1068 vs. 890, p = 0.03) and pedestrian-related injuries decreased by 2.7% (n = 227 vs. 143, p < 0.01); however, burn injuries increased by 2.2% (n = 134 vs. 174, p < 0.01) and violence-related injuries increased by 0.9% (n = 45 vs. 60, p = 0.05) post easing of lockdown restrictions. We observed an increase in in-hospital mortality during the period of 12 months after easing of lockdown restrictions-4.9% (114/2336) compared to 12 months of pre-lockdown period-4.3% (113/2593). CONCLUSION: This is one of the first studies to document trauma trends over a one-year period after easing lockdown restrictions. MVC continues to be the leading cause of injuries despite a slight decrease; overall injury cases rebounded towards pre-lockdown levels in Saudi Arabia. Injury prevention needs robust legislation with respect to road safety measures and law enforcement that can decrease the burden of traumatic injuries.

Effect of Stay-at-Home orders and other COVID-related policies on trauma hospitalization rates and disparities in the USA: a statewide time-series analysis.

BACKGROUND: To combat the coronavirus pandemic, states implemented several public health policies to reduce infection and transmission. Increasing evidence suggests that these prevention strategies also have had a profound impact on non-COVID healthcare utilization. The goal of this study was to determine the impact of a statewide Stay-at-Home order and other COVID-related policies on trauma hospitalizations, stratified by race/ethnicity, age, and sex. METHODS: We used the North Carolina Trauma Registry, a statewide registry of trauma hospitalizations for 18 hospitals across North Carolina, including all North Carolina trauma centers, to calculate weekly rates of assault, self-inflicted, unintentional motor vehicle collision (MVC), and other unintentional injury hospitalizations between January 1, 2019, and December 31, 2020. Interrupted time-series design and segmented linear regression were used to estimate changes in hospitalization rates after several COVID-related executive orders, overall and stratified by race/ethnicity, age, and sex. Changes in hospitalization rates were assessed after 1) USA declaration of a public health emergency; 2) North Carolina statewide Stay-at-Home order; 3) Stay-at-Home order lifted with restrictions (Phase 2: Safer-at-Home); and 4) further lifting of restrictions (Phase 2.5: Safer-at-Home). RESULTS: There were 70,478 trauma hospitalizations in North Carolina, 2019-2020. In 2020, median age was 53 years old and 59% were male. Assault hospitalization rates (per 1,000,000 NC residents) increased after the Stay-at-Home order, but substantial increases were only observed among Black/African American residents (weekly trend change = 1.147, 95% CI = 0.634 to 1.662) and 18-44-year-old males (weekly trend change = 1.708, 95% CI = 0.870 to 2.545). After major restrictions were lifted, assault rates decreased but remained elevated compared to pre-COVID levels. Unintentional non-MVC injury hospitalizations decreased after the USA declared a public health emergency, especially among women ≥ 65 years old (weekly trend change = -4.010, 95% CI = -6.166 to -1.855), but returned to pre-pandemic levels within several months. CONCLUSIONS: Statewide Stay-at-Home orders placed Black/African American residents at higher risk of assault hospitalizations, exacerbating pre-existing disparities. Males 18-44 years old were also at higher risk of assault hospitalization. Fear of COVID-19 may have led to decreases in unintentional non-MVC hospitalization rates, particularly among older females. Policy makers must anticipate policy-related harms that may disproportionately affect already disadvantaged communities and develop mitigation approaches.