Bus passenger injury prevention: Learning from onboard incidents.

OBJECTIVE: Bus travel is relatively safe: however there remains a lack of understanding of passenger injury incidents onboard buses. The objective of this study was to understand more about onboard passenger incidents to help inform injury mitigation. METHODS: The UK national STATS19 data and Transport for London bus incident data (IRIS) were used to determine the size of the problem in Greater London. Other data including onboard incident reports from two bus operators and CCTV footage of 70 incidents were used to understand passenger injury in more depth and identify common themes and challenges. RESULTS: The STATS19 and IRIS analysis showed that there was a difference between nationally reported bus incidents compared to locally reported bus incidents. Non-collision incidents are prevalent in the data suggesting there is a large problem to tackle. The CCTV and bus incident data identified braking to be the single largest problem in onboard bus passenger injury incidents. Inconsistent reporting of passenger incidents and injury descriptions make it difficult to identify injury patterns and trends. Areas on the bus appear to contribute to higher injury incidents namely those seats facing and closest to the wheelchair area. Other challenges relating to expected passenger and driver behaviors were noted where blame for the incident and outcome can be attributed to both parties. CONCLUSIONS: This combined analysis of incident reports and CCTV footage has enabled a better understanding of the events leading to on-board passenger injury incidents. Preventing harsh braking would appear to be the most effective way of reducing passenger injuries. Additionally improved data collection would assist both transport authorities and bus operators to identify and monitor the effect of bus safety improvements.

Evaluating narrative exposure therapy for post-traumatic stress disorder and depression symptoms: A meta-analysis of the evidence base.

Narrative exposure therapy (NET) is an intervention for trauma spectrum disorders. Originally developed to treat refugee populations, NET has since been tested for efficacy across different settings. In this review, the NET evidence base is examined through a retrieval, synthesis and appraisal of randomized controlled trials (RCTs) published since 2002. Two independent reviewers (S. R. and N. S.) searched online databases including EMBASE, PsycINFO and PubMed. Twenty-four RCTs were selected for a meta-analysis of three outcomes: post-traumatic stress disorder (PTSD) diagnosis and PTSD and depression symptoms. All outcomes were analysed at short-term (3-4 months), midterm (6-7 months) and long-term (≥12 months) data points. A random-effects model was applied to yield standardized mean differences (SMDs) and odds ratios (ORs) as indicators of NET treatment effect. Subgroup analyses for type of trauma and type of control groups were conducted to examine potential heterogeneity. For the NET group, moderate effect sizes for PTSD symptom severity were observed at midterm and long term and at midterm for depression symptom severity. The number of PTSD diagnoses decreased significantly in the short term for the NET condition, but this was not sustained at the long term. Caution must be exercised when interpreting these results due to high heterogeneity estimates and low quality of evidence across trials. Potential small-study effects further complicate the interpretation of the findings. Recommendations are made for augmenting statistical significance research with qualitative analyses of NET efficacy to better inform clinical practice.