Addressing the association between driving with an expired vehicle inspection certificate and injury severity after a crash.

OBJECTIVES: The aim of this study was to quantify the association between driving a vehicle with an expired vehicle inspection certificate (DEVIC) and the severity of injuries sustained by drivers involved in collisions. METHODS: A cohort study was designed to compare the incidence of minor injuries, major injuries, and deaths between DEVIC and non-DEVIC drivers involved in collisions. We selected all 51,305 non-responsible drivers (i.e., drivers who did not commit an error or infraction) involved in clean collisions (those in which only one driver in multivehicle collisions committed a traffic infraction or error) from the population of drivers of four-wheeled motor vehicles involved in crashes recorded in the National Register for Road Traffic Accident Victims in Spain from 2014 to 2017. RESULTS: DEVIC was not related with a greater severity of drivers' injuries. The adjusted estimates for the association between DEVIC and major injuries or death yielded an odds ratio of 0.91 (0.66-1.25), compared to no injuries or minor injuries, and a relative risk ratio of 0.90 (0.65-1.24) compared to no injuries. CONCLUSIONS: Although we have not found an association between DEVIC and drivers' injury severity, the study limitations does not allow us to discard the usefulness of periodic vehicle inspection in reducing the risk of more severe injury among drivers involved in road crashes.

Prevalence of and Factors Associated with Driving a Vehicle with Timed-Out Inspection Certificate in Spain.

This study aimed to estimate the prevalence of vehicles on the road with a timed-out vehicle inspection certificate (TOVIC) and the associations of driver, vehicle, and environmental factors with this infraction. A quasi-induced exposure approach was used in this cross-sectional study to analyze a case series comprising 51,305 drivers passively involved in clean collisions (only one infractor driver involved) between two or more vehicles registered in the Spanish National Register of Road Crashes with Victims from 2014 to 2017. The prevalence of TOVIC was estimated in the whole sample and in subgroups defined by the variables considered. Multivariate logistic regression modeling was used to obtain adjusted odds ratios for the association between TOVIC and each category of the variables. The prevalence of TOVIC was low, although significant differences were found for certain subcategories of drivers, vehicles, and environmental factors. Significant positive adjusted associations were found between TOVIC and license-related infractions, vans (compared to cars), vehicle age, and vehicle defects. Several vehicle-related factors potentially associated with a high risk of involvement in a crash were clearly related with TOVIC, which suggests the need for measures to control this non-negligible number of high-risk vehicles on the road.

Individual and environmental factors associated with death of cyclists involved in road crashes in Spain: a cohort study.

OBJECTIVE: To quantify the magnitude of associations between cyclist fatalities and both cyclist and environment related characteristics in Spain during the first 24 hours after a crash. DESIGN: Cohort study. SETTING: Spain. PARTICIPANTS: 65 977 cyclists injured in road crashes recorded between 1993 and 2013 in the Spanish Register of Road Crashes with Victims. MAIN OUTCOME: Death within the first 24 hours after the crash. METHODS: A multiple imputation procedure was used to mitigate the effect of missing values. Differences between regions were assumed and managed with multilevel analysis at the cyclist and province levels. Incidence density ratios (IDR) with 95% CI were calculated with a multivariate Poisson model. RESULTS: Non-use of a helmet was directly associated with death (IDR 1.43, 95% CI 1.25 to 1.64). Among other cyclist characteristics, age after the third decade of life was also directly associated with death, especially in older cyclists ('over 74' category, IDR 4.61, 95% CI 3.49 to 6.08). The association with death did not differ between work-related cycling and other reasons for cycling.There was an inverse association with death for crashes in urban areas and on community roads. Any adverse meteorological condition also showed a direct association with death, whereas altered road surfaces showed an inverse association. Crashes during nighttime were directly associated with death, with a peak between 3:00 and 5:59 am (IDR 1.58, 95% CI 1.03 to 2.41). CONCLUSIONS: We found strong direct and inverse associations between several cyclist and environment related variables and death. These variables should be considered in efforts to prioritise public health measures aimed at reducing the number of cycling-related fatalities.

[Risk factors for provoking collisions between cyclists and pedestrians in Spain, 1993-2011]. / Factores asociados al riesgo de provocar una colisión entre un ciclista y un peatón en España, 1993-2011.

OBJECTIVE: To identify and quantify the factors depending on pedestrians, cyclists and the environment associated with the risk of causing a collision between a cyclist and a pedestrian in Spain from 1993 to 2011. STUDY DESIGN: retrospective case series. POPULATION: 1228 pedestrian-cyclist pairs involved in the same number of collisions in an urban area, only one of whom committed an infraction. SOURCE: Register of Traffic Accidents with Victims, supported by the Spanish Traffic General Directorate. VARIABLES: committing an infraction (yes/no), age, sex, helmet use (cyclist), hour, type of day, year, existence of sidewalks, place of the accident, and priority regulated. ANALYSIS: logistic regression model to estimate the strength of the association between the pedestrian's responsibility and independent variables. The association with the cyclist's responsibility was assessed by reversing the value of the odds ratios obtained. RESULTS: In both groups of users, the risk of causing a collision was higher in extreme ages. Female cyclists had a slightly higher risk than male cyclists, while the use of a helmet had a protective effect. The risk of the pedestrian causing an accident was higher in the absence of sidewalks. Cyclists more frequently provoked accidents in crosswalks. CONCLUSION: We recommend the implementation of safety campaigns aimed at pedestrians and cyclists, with special attention paid to the youngest and older people. Interventions for correct road use would also be advisable.

[Drug use and involvement in risky driving styles in a sample of university students. The uniHcos project]. / Consumo de drogas e implicación en estilos de conducción de riesgo en una muestra de estudiantes universitarios. Proyecto uniHcos.

OBJECTIVE: Drug and alcohol use are known to increase the risk of traffic accidents, especially among youth. However, the association between habitual drug use and the adoption of risky driving behavior is not well known. The aim of this study was to identify and quantify the association between habitual drug use and involvement in risky driving practices overall and by gender among university students. METHODS: A cross sectional study was conducted. The study population was composed of 559 car drivers younger than 31 years who completed an online questionnaire during the 2011-2012 academic year. Among other factors, the questionnaire assessed the following items: habitual drug consumption (20 or more days) during the last year and involvement in other risky driving practices during the last month. RESULTS: A total of 27.7% of students reported they had used drugs regularly during the last year. Drug use was associated with a higher frequency of involvement in risky driving practices. In men, the factors most strongly associated with drug consumption were speeding, driving under influence of alcohol, and feeling drowsy while driving. In women, drug consumption was mainly associated with smoking while driving, drunk driving, and driving without rest. CONCLUSION: The results of our study support the hypothesis that habitual drug use is associated with an increased frequency of risky driving behavior.

Consumo de drogas e implicación en estilos de conducción de riesgo en una muestra de estudiantes universitarios. Proyecto uniHcos / Drug use and involvement in risky driving styles in a sample of university students. The uniHcos Project

Objetivo: El consumo de drogas y alcohol son conocidos factores que incrementan el riesgo de accidente de tráfico, en especial en los jóvenes. Sin embargo, no son tan bien conocidas las asociaciones entre el consumo habitual de drogas y la adopción de conductas de riesgo al volante. El objetivo de este estudio fue identificar y cuantificar, globalmente y por género, la asociación entre el consumo habitual de drogas y la implicación en circunstancias de conducción de riesgo en universitarios/as. Métodos: Se realizó un estudio transversal. La población de estudio se compuso de 559 universitarios menores de 31 años y conductores de turismo que, durante el curso académico 2011-2012, cumplimentaron un cuestionario online en el que se valoraban, entre otros aspectos, el consumo habitual de drogas (20 o más días) durante el último año y la implicación durante el último mes en diversas circunstancias de conducción de riesgo. Resultados: Un 27,7% de los estudiantes consumieron drogas de forma habitual durante el último año. El consumo de drogas se asoció a una mayor implicación en circunstancias de riesgo al volante. En los hombres, las circunstancias más fuertemente asociadas a dicho consumo fueron conducir a velocidad excesiva, conducir tras consumir alcohol y conducir con sueño. En las mujeres, dicho consumo se asoció principalmente a fumar al volante, conducir tras consumir alcohol y no descansar. Conclusiones: Los resultados apoyan la hipótesis de que el consumo habitual de drogas se asocia a una mayor frecuencia de adopción de conductas de riesgo al volante (AU)

Objective: Drug and alcohol use are known to increase the risk of traffic accidents, especially among youth. However, the association between habitual drug use and the adoption of risky driving behavior is not well known. The aim of this study was to identify and quantify the association between habitual drug use and involvement in risky driving practices overall and by gender among university students. Methods: A cross sectional study was conducted. The study population was composed of 559 car drivers younger than 31 years who completed an online questionnaire during the 2011-2012 academic year. Among other factors, the questionnaire assessed the following items: habitual drug consumption (20 or more days) during the last year and involvement in other risky driving practices during the last month. Results: A total of 27.7% of students reported they had used drugs regularly during the last year. Drug use was associated with a higher frequency of involvement in risky driving practices. In men, the factors most strongly associated with drug consumption were speeding, driving under influence of alcohol, and feeling drowsy while driving. In women, drug consumption was mainly associated with smoking while driving, drunk driving, and driving without rest. Conclusion: The results of our study support the hypothesis that habitual drug use is associated with an increased frequency of risky driving behavior (AU)

Factores asociados al riesgo de provocar una colisión entre un ciclista y un peatón en España, 1993-2011 / Risk factors for provoking collisions between cyclists and pedestrians in Spain, 1993-2011

Objetivo: Identificar y cuantificar los factores dependientes del peatón, del ciclista y del ambiente asociados a un mayor riesgo de ser causa de una colisión entre un ciclista y un peatón en España, entre 1993 y 2011. Métodos: Diseño del estudio: serie de casos retrospectiva. Población: 1228 pares peatón-ciclista implicados en otras tantas colisiones en zona urbana, en las que sólo uno de los dos cometió una infracción. Fuente de información: Registro de Accidentes de Tráfico con Víctimas de la Dirección General de Tráfico. Variables: comisión de infracción (sí/no), edad, sexo, uso de casco (ciclista), hora, tipo de día, año, presencia de aceras, lugar del accidente, prioridad regulada. Análisis: modelo de regresión logística para estimar la fuerza de la asociación entre la responsabilidad del peatón y las variables independientes. Invirtiendo el valor de las odds ratios obtenidas se valoró la asociación con la responsabilidad del ciclista. Resultados: En ambos grupos de usuarios, el riesgo de ser responsable de la colisión fue mayor en las edades extremas. Las mujeres ciclistas presentaron un riesgo ligeramente mayor que los hombres, mientras que usar casco tuvo un efecto protector. El riesgo de que el peatón fuera responsable fue mayor en ausencia de aceras. Los ciclistas provocaron con más frecuencia los atropellos en los pasos de peatones. Conclusión: Sería recomendable implementar campañas de seguridad vial dirigidas a peatones y ciclistas, prestando especial atención a jóvenes y ancianos. Las intervenciones para el uso correcto de la calzada también serían de utilidad (AU)

Objective: To identify and quantify the factors depending on pedestrians, cyclists and the environment associated with the risk of causing a collision between a cyclist and a pedestrian in Spain from 1993 to 2011. Methods: Study design: retrospective case series. Population: 1228 pedestrian-cyclist pairs involved in the same number of collisions in an urban area, only one of whom committed an infraction. Source: Register of Traffic Accidents with Victims, supported by the Spanish Traffic General Directorate. Variables: committing an infraction (yes/no), age, sex, helmet use (cyclist), hour, type of day, year, existence of sidewalks, place of the accident, and priority regulated. Analysis: logistic regression model to estimate the strength of the association between the pedestrian's responsibility and independent variables. The association with the cyclist's responsibility was assessed by reversing the value of the odds ratios obtained. Results: In both groups of users, the risk of causing a collision was higher in extreme ages. Female cyclists had a slightly higher risk than male cyclists, while the use of a helmet had a protective effect. The risk of the pedestrian causing an accident was higher in the absence of sidewalks. Cyclists more frequently provoked accidents in crosswalks. Conclusion: We recommend the implementation of safety campaigns aimed at pedestrians and cyclists, with special attention paid to the youngest and older people. Interventions for correct road use would also be advisable (AU)

Estudios poblacionales en España sobre daños relacionados con el consumo de alcohol / Population based studies on alcohol-related harm in Spain

A partir de la revisión de los principales artículos científicos e informes así como del análisis de algunos datos secundarios, se evaluaron los problemas relacionados con el consumo de alcohol en España entre 1990 y 2011. En 2011 pudo ser atribuibles al alcohol el 10% de la mortalidad total y aproximadamente el 30% de la mortalidad por accidente de tráfico en la población de 15-64 años. En esta misma población al menos el 0,8% padecía trastornos por consumo de alcohol, el 5% adicional podía tener problemas que necesitaban evaluación y aproximadamente el 20% había tenido alguna intoxicación etílica aguda (IEA) en el último año. Las IEA supusieron aproximadamente el 0,5-1,1% de las urgencias hospitalarias. Los costes sociales totales del consumo de alcohol podrían representar el 1% del producto interior bruto. La probabilidad de daños relacionados con el consumo de alcohol es bastante mayor en hombres que en mujeres, con una razón hombre/mujer de mortalidad o daños graves relacionados con alcohol de 3/4, situación que apenas ha cambiado en los últimos 20 años. Los daños relacionados con alcohol han seguido una tendencia descendente, excepto la IEA. En el período 1990-2011 la tasa estandarizada de mortalidad relacionada con consumo de alcohol alcohol disminuyó a la mitad. Las grandes lagunas de conocimiento y las incertidumbres sobre los daños poblacionales relacionados con el alcohol en España justifican el apoyo institucional a su investigación y la puesta en marcha de un sistema integral de monitorización (AU)

Based on the review of scientific papers and institutional reports on the subject and analysis of some secondary data, we assess the alcohol related harm in Spain between 1990 and 2011. In 2011 they could be attributable to alcohol, 10%of the total mortality of the population aged 15-64, and about 30% of deaths due to traffic accidents. Among the population aged 15-64 years at least 0.8%had alcohol use disorders, an additional 5% could have harmful alcohol consumption that would need clinical evaluation, and about 20% had had some acute alcohol intoxication (AAI) in the last year. The AAI accounted for approximately 0.5-1.1 % of hospital emergency visits. Social costs of alcohol could represent 1% of gross domestic product. The prevalence of alcohol-related harm was significantly higher in men than women, with a male/female ratio greater than three for alcohol-related mortality and serious injuries, and this situation has hardly changed in the last 20 years. Alcohol-related harm has followed a downward trend, except for AAI. In 1990-2011 the standardized mortality rates related to alcohol decreased by half. Large gaps in knowledge and uncertainties on alcohol-related harm in Spanish population, clearly justify the institutional support for the research in this field and the implementation of a comprehensive monitoring system (AU)

Time devoted to pre- and post-HIV test counselling in different health services according to participants of a rapid testing program in Madrid, Spain

INTRODUCTION: The role of pre- and post-test counselling in new HIV testing strategies to reduce delayed diagnosis has been debated. Data on time devoted to counselling are scarce. One approach to this problem is to explore patients' views on the time devoted to counselling by venue of their last HIV test. Methods We analysed data from 1568 people with a previous HIV test who attended a mobile HIV testing program in Madrid between May and December 2008.ResultsThe majority (71%) were men (48% had had sex with other men), 51% were <30 years, 40% were foreigners, 56% had a university degree, and 40% had the most recent HIV test within the last year. As regards pre-test counselling, 30% stated they were told only that they would receive the test; 26.3% reported <10 min; 20.4% about 10 min; and 24.2%, 15 min or more. For post-test counselling: 40.2% stated they were told only that the test was negative; 24.9% reported 2-6 min; 16.4% about 10 min; and 18.5%, 15 min or more. The percentage of participants who reported no counselling time was higher among those tested in general health services: primary care, hospital settings and private laboratories (over 40% in pre-test, over 50% in post-test counselling). Women received less counselling time than men in almost all settings. Conclusion Policies to expand HIV testing in general health services should take this current medical behaviour into account. Any mention of the need for counselling can be a barrier to expansion, because HIV is becoming less of a priority in developed countries. Oral consent should be the only requirement

INTRODUCCIÓN: Las nuevas estrategias para reducir el diagnóstico tardío de VIH ponen en entredicho el papel del consejo pre-post test. Existe poca información sobre el tiempo dedicado al consejo. Un posible enfoque es explorar las opiniones de los pacientes sobre el tiempo dedicado al consejo según el lugar de la última prueba MÉTODOS: Se analizan 1568 personas con prueba previa de VIH que acuden a un programa móvil en Madrid entre Mayo y Diciembre de 2008. RESULTADOS: 71% eran hombres (48% hombres que tienen sexo con hombres), 51% < 30 años, 40% extranjeros, 56% universitarios y el 40% se hizo la última prueba en el ultimo año. Con respecto al consejo pre-test, el 30% refirió que únicamente se les comunicó que se les iba a realizar la prueba, el 26,3% reportó < 10 minutos, 20,4% alrededor de 10 y 24,2% 15 o más. Para el consejo post-test: el 40% refirió que únicamente se les comunicó el resultado negativo, 24,9% entre 2-6 minutos, 16,4% alrededor de 10 y 18,5% 15 o más. El porcentaje de participantes que dijo no recibir consejo fue mayor entre quienes se la habían hecho en servicios generales: atención primaria, hospitales y laboratorios privados (más del 40% en pre-test y más del 50% en post-test). En prácticamente todas las localizaciones, a las mujeres se les dedicó menos tiempo. CONCLUSIÓN: Las políticas para expandir la prueba de VIH en servicios generales deben considerar el comportamiento médico actual. Cualquier mención a la necesidad de consejo puede resultar una barrera a la expansión puesto que el VIH ya no es prioridad en los países desarrollados. El consentimiento verbal debiera ser el único requisito

Time devoted to pre- and post-HIV test counselling in different health services according to participants of a rapid testing program in Madrid, Spain.

INTRODUCTION: The role of pre- and post-test counselling in new HIV testing strategies to reduce delayed diagnosis has been debated. Data on time devoted to counselling are scarce. One approach to this problem is to explore patients' views on the time devoted to counselling by venue of their last HIV test. METHODS: We analysed data from 1568 people with a previous HIV test who attended a mobile HIV testing program in Madrid between May and December 2008. RESULTS: The majority (71%) were men (48% had had sex with other men), 51% were <30 years, 40% were foreigners, 56% had a university degree, and 40% had the most recent HIV test within the last year. As regards pre-test counselling, 30% stated they were told only that they would receive the test; 26.3% reported <10 min; 20.4% about 10 min; and 24.2%, 15 min or more. For post-test counselling: 40.2% stated they were told only that the test was negative; 24.9% reported 2-6 min; 16.4% about 10 min; and 18.5%, 15 min or more. The percentage of participants who reported no counselling time was higher among those tested in general health services: primary care, hospital settings and private laboratories (over 40% in pre-test, over 50% in post-test counselling). Women received less counselling time than men in almost all settings. CONCLUSION: Policies to expand HIV testing in general health services should take this current medical behaviour into account. Any mention of the need for counselling can be a barrier to expansion, because HIV is becoming less of a priority in developed countries. Oral consent should be the only requirement.

Decomposing the association between the amount of exposure and the frequency of self-reported involvement in a road crash.

We tried to obtain preliminary evidence to test the hypothesis that the association between driving exposure and the frequency of reporting a road crash can be decomposed into two paths: direct and indirect (mediated by risky driving patterns). In a cross-sectional study carried out between 2007 and 2010, a sample of 1114 car drivers who were students at the University of Granada completed a questionnaire with items about driving exposure during the previous year, risk-related driving circumstances and involvement in road crashes. We applied the decomposition procedure proposed by Buis for logit models. The indirect path showed a strong dose-response relationship with the frequency of reporting a road crash, whereas the direct path did not. The decomposition procedure was able to identify the indirect path as the main explanatory mechanism for the association between exposure and the frequency of reporting a road crash.

Comparison of two methods to assess the effect of age and sex on the risk of car crashes.

BACKGROUND: This study was designed to compare two methods (direct measurement of exposure and quasi-induced exposure) for assessing the effect of age and sex on the risk of being involved in a car crash in Spain. METHODS: Spanish crash rates (per 10,000,000 driver-km) for age and sex groups of drivers aged 18-64 years old were obtained for 2004-2007, using information from the Spanish General Traffic Office (census of reported car crashes) and the Spanish Household Survey on Alcohol and Drugs (estimate of the mean km driven for each car driver). The rate ratios estimated by direct exposure estimates were compared to those obtained with the quasi-induced exposure method, which compares the age and sex of responsible and non-responsible drivers involved in the same clean collision (in which only one of the drivers committed a driving infraction). RESULTS: Both methods detected an increased risk of involvement in a crash for the youngest (18-20 years) and the oldest drivers (60-64 years), compared to middle-aged drivers (45-49 years). However, the rate ratios obtained with the quasi-induced method for the youngest group (2.0 for men, 1.6 for women) were much lower than those obtained with crash rates (13.4 for men, 5.7 for women). Both methods detected a similar increase in the risk of involvement of male drivers compared to women in the youngest age group. This excess risk for men was maintained with increasing age up to 45-49 years when the quasi-induced method was used. However, direct comparisons of crash rates revealed an increased risk of involvement in women compared to men of the same age from 25-29 years onward. CONCLUSIONS: Both direct measurement of driving exposure and the quasi-induced exposure method detected some well-known patterns of risk associated with driver's age and sex. However, factors that could explain important differences between the two methods deserve attention, especially those related with the excess risk for the youngest drivers as well as sex-related risk.