Over 200 million people suffer from osteoporosis worldwide, which occurs when bone tissues become structurally deteriorated and bone mass becomes fragile, resulting in an increased risk of fracture. This review aims to describe the underlying risk factors and provide guidance on changes in lifestyle for those at risk of developing osteoporosis. It highlights risk factors such as age, sex, genetic background, and other under lying illnesses (factors that are generally “non-modifiable”). Furthermore, it focuses on factors that are dependent on lifestyle and (local) habits (factors that are “modifiable”), such as diet, sunlight exposure, exercise, and medication. Clearly, osteoporosis is a multifactorial disease and multiple of these risk factors can occur simultaneously. Currently, the data available differ greatly between regions and some areas might be affected more seriously than others. This review suggests that this might be due to differing healthcare training systems and suboptimal awareness of osteoporosis. Importantly, osteoporosis and resulting bone fractures represent a significant economic burden for both individuals and the wider society. Therefore, improved awareness of the disease may influence personal habits, reduce suffering, and alleviate the burden on healthcare expenditure.
Background: Diagnosis and treatment of tropical acute febrile illnesses is challenging with respect to health facilities and personnel and diagnostic kits. Platelet indices are available at no extra cost or blood requirements. They are useful in diagnosing both infective and non-infective diseases. However, these indices have not been used previously to predict the differential diagnosis of common tropical febrile illnesses using a decision tree. Methods: A retrospective analysis of clinical and laboratory data of 402 patients with fever lasting for >24 h and < 3 weeks was performed. Subjects were divided into seven diagnostic groups: bacterial, viral, rickettsial, parasitic, mycobacterial, undifferentiated, and non-infective. Bivariate correlation and distribution of platelet indices among the diagnostic groups were examined. The area under the curve was obtained using these indices for each group. A classification tree was also constructed with these indices and other variables sequentially, to predict the likely cause of the fever. Results: Subjects were predominantly males (255) and young individuals (242). The most common causes of fever were viral (18.2%) and bacterial (16.8%) infections. Platelet indices varied significantly across all the groups, even after controlling for other clinical/laboratory parameters. Receiver-operating characteristic analysis showed that high platelet count had the best sensitivity and specificity for diagnosis of tuberculosis. The classification tree constructed using platelet indices alone had a higher margin of error than that using a combination of clinical symptoms, complete blood count, liver function tests, and ECG heart rate. Conclusions: Platelet indices vary significantly across tropical illnesses. Thrombocytosis has good sensitivity and specificity for diagnosis of tuberculosis. Combined with clinical symptoms and routine blood tests, these indices predicted a likely diagnosis in two-thirds of patients. Prospective validation in different localities is needed prior to the use of these indices in the diagnosis of acute febrile illnesses.
Lead is one of the oldest toxins existing in the environment that can affect almost all organs of the body without any noticeable symptom. Depending on its concentration in the body, lead may cause lower IQ level, autism, abnormal pregnancy outcome, abortion, and increased involvement in crime. As lead can cross the placental barrier and affect the fetus, pregnant women, fetuses, and children are more vulnerable to lead poisoning because of rapid bone mobilization and neurodevelopment. Therefore, this study aimed to evaluate the awareness of lead exposure among Bangladeshi women of childbearing age on the basis of their educational level. A questionnaire survey was conducted among the participants comprising both less-educated (n = 62) and more-educated (n = 52) women. Data were analyzed using SPSS (version20), and relevant statistical techniques were used to draw the results. The findings showed highly significant differences between the two groups in relation to economic condition, lifestyle, residential location, use of traditional cosmetics, and food habit (p < 0.0001). Although the more-educated women claimed that they were aware of the harmful effects of lead, as opposed to the less-educated women not being aware (p < 0.0001), they failed to substantiate their claim because this was not reflected in their everyday practices as revealed by the ‘previous birth outcome records’ of their fetuses. This indicated that their knowledge or awareness of lead, particularly its sources and detrimental effects, remained superficial, and their educational background had no statistically significant difference with respect to the awareness of lead toxicity (p = 0.103). Given that a mother's exposure to lead can directly affect her fetus, this study bears high significance, as the results imply that if women are aware of the sources of lead and the consequences of lead poisoning, the body burden of lead could be reduced in the next generation, which, in turn, would have a high economic impact.
تعتبر السلامة المرورية من أهم الوسائل في حماية أرواح البشر وحماية الممتلكات الخاصة والعامة من التلف والمساهمة في النمو والتطور الاجتماعي والاقتصادي. وترتبط السلامة المرورية بعوامل عديدة ويأتي في مقدمتها ثلاثة عوامل أساسية وهي: 1-قائد المركبة, 2-المركبة, 3-الطريق. ولأن هذه الورقة العلمية ستركز فقط على قائد المركبة لكونه العامل الرئيس والمؤثر على بقية العوامل الأخرى. وسنتناول جانب مهم من سلوك قائد المركبة والمتعلق بتعاطي المخدرات والمؤثرات العقلية Psychoactive Substances . وعلاقة ذلك السلوك بالحوادث المرورية والسلامة المرورية. فمن ناحية تشير الاحصاءات الرسمية في المملكة العربية السعودية حتى عام (2014) ان الحوادث المرورية ازدادت في العشر سنوات الماضية بنسبة (400%) وخلال (23سنة) الماضية بلغ عدد المصابين في حوادث المرور أكثر من نصف مليون مصاب, وستون الف حالة وفاة, وبمعدل سنوي أربعة ألاف ومئتين حالة وفاة سنويا, وبمعدل ألف ومئتين اعاقة دائمة سنويا, وبمعدل ثمانية آلاف إعاقة مؤقتة سنويا. ومن ناحية أخرى تشير الاحصاءات الرسمية في المملكة العربية السعودية بان مشكلة المخدرات والمؤثرات العقلية قد تضاعفت لعشرات المر...
Significant reductions in road trauma among young drivers could be achieved if they drove safer vehicles. Parents are likely to play a critical role in the access, timing of vehicle purchase, available budget, and vehicle choice for the young driver’s first vehicle. However, little attention has been directed to understanding the most effective communication strategies to encourage young drivers and their parents to purchase and use safe vehicles. This study was undertaken to examine existing strategies in Australia and provide recommendations for improving communication initiatives. A two-staged study was undertaken including in-depth consultation with representatives from key road safety stakeholders groups to identify current initiatives, and development of conceptual model to identify current and potential improvements to communication strategies. The findings of the consultation phase showed that a sporadic and un-coordinated approach was used regarding the promotion of key messages for purchase and use of safe vehicles and there was some suggestion that the communication medium, content and message style may not reach the target audience in the most effective way. Stakeholder representatives were unanimous in the argument that parents play an integral role. A conceptual framework was developed, depicting key stakeholders in Australia and the various interactions across stakeholders. This was instrumental in identifying areas where effective communicative initiatives and resources could be considered to increase the purchase and use of safe vehicles, including development of a widespread and accessible website and inclusion of vehicle safety choices in young driver education and training programs. The results of the study suggest that a National Framework that co-ordinates government and non-government activities and initiatives aimed at encouraging the purchase and usage of safer vehicles by parents and young drivers should be developed. The methodology can be applied to other countries to develop similar communication campaigns.
The Department of Transport (DoT) in Abu Dhabi has recognised that while minibuses play a key role in transporting people within the United Arab Emirates, levels of fatal and serious injury among minibus occupants in crashes are high. As a first step toward addressing this problem, the DoT commissioned a benchmarking study to gain an understanding of the state of the minibus fleet, focusing on fundamental vehicle safety aspects, as well as fitment rates of safety features such as airbags and stability control systems. Furthermore, the in-service condition of vehicles was also assessed. Data was collected from 566 minibuses in Abu Dhabi and Dubai, comprising more than 80 separate data points characterising the presence, nature and condition of each vehicle. An innovative system was developed to combine these variables to yield a weighted safety score that allowed them to be grouped into categories for later input into a benefit cost analysis of a replacement program. A star rating system was used for the categorisation process because it allows for good discrimination between safety levels while remaining easy to comprehend. The results of the benchmarking study showed that despite the fleet being quite uniform by make and model, there was considerable variation among individual vehicles in terms of seat belt fitment rates and rear passenger compartment seat mounting integrity in particular. Many vehicles in current operation are deficient both in terms of primary and secondary safety, compounded by inconsistent fitment of passenger seat belts. This in-depth survey has provided significant additional information unavailable from registration data and provides a valuable insight into the state of minibus safety in the UAE. The data acquired will be used to conduct a benefit cost analysis targeted at determining the optimal means for implementing significant improvements to the minibus fleet.
A research team from Texas A&M University at Qatar (TAMUQ) and Texas A&M Transportation Institute (TTI) conducted during the past three years a study that focused on traffic safety situation in Qatar, tyre properties, and the influence of tyre properties on driving safety. The presentation will compare and contrast the specifications of the Gulf Standardization Organization (GSO) and other specifications used in Europe and United States. Consequently, the presentation will discuss recommendation for changes in GSO tyre specifications in order to better reflect climatic conditions in the region. One of the road safety issues in Qatar is the routine use of some drivers of off-road tyres on paved roads. The research team conducted comprehensive testing of off-road tyres and standard tyres that are used in a typical large SUV. In addition, the team developed computer models and conducted finite element analysis to simulate the driving and manoeuvring conditions of the different types of tyres. The experimental measurements and computer simulations revealed valuable information about performance of off-road tyres and risks associated of using them on roads in Qatar. The results will be very useful for the policy makers and the driving public regarding the development of regulations that control the use of off-road tyres.
Fatal vehicle crashes are not uncommon for ambulance paramedics (1-3). Emergency services staff may be overconfident and overestimate the privileges they have on the road and overlook basic driving safety principles (4). In line with the WHO (5) a driving safety campaign targeting some 935 registered HMCAS drivers and other staff was initiated in June 2015. We aim to determine if our approach is effective in changing behaviour and believes, and reducing the number of accidents in which our vehicles are involved, and surveyed the staff. Posters and stickers were designed with respectively 6 and 4 key messages covering the most frequent issues resulting in collisions (with objects/other vehicles) or potentially putting lives at risk. These are visibly displayed at all ambulance stations and in the vehicle driving compartments. An official staff circular was then sent to inform them of the campaign. A month later a survey accessible online and on paper started to be distributed to staff. In one month 141 anonymous questionnaires were returned fully completed. On average using a 5-point Likert scale respondents rated themselves as being safe drivers (4.2/5) and estimated the monthly number of accident with HMCAS vehicles to be 15.3 (22.1/month registered in 2014) and to mainly occur at traffic light (75.2%). 75% had noticed the posters and 60% the stickers. Those who noticed could respectively cite 53.3% (3.2) and 54.6% (2.2) of the key messages. 72% of respondents (n=102) had an HMCAS driving qualification (10.9% of qualified HMCAS drivers). On average they had been involved in 0.95 accident requiring vehicle repair. As expected, staff underestimate the number of accidents. References: 1- Maguire, B. J., Hunting, K. L., Smith, G. S., & Levick, N. R. (2002). Occupational fatalities in emergency medical services: a hidden crisis. Annals of emergency medicine, 40(6), 625-632. 2- Maguire, B. J., & Smith, S. (2013). Injuries and fatalities among emergency medical technicians and paramedics in the United States. Prehospital and disaster medicine, 28(04), 376-382. 3- Becker, L. R., Zaloshnja, E., Levick, N., Li, G., & Miller, T. R. (2003). Relative risk of injury and death in ambulances and other emergency vehicles. Accident Analysis & Prevention, 35(6), 941-948. 4- Blau, G., Gibson, G., Hochner, A., & Portwood, J. (2012). Antecedents of Emergency Medical Service high-risk behaviors: Drinking and not wearing a seat belt. Journal of Workplace Behavioral Health, 27(1), 47-61. 5- World Health Organization. (2013). WHO global status report on road safety 2013: supporting a decade of action. World Health Organization. 6- Abu-Zidan, F. M., Abbas, A. K., Hefny, A. F., Eid, H. O., & Grivna, M. (2012). Effects of seat belt usage on injury pattern and outcome of vehicle occupants after road traffic collisions: prospective study. World journal of surgery, 36(2), 255-259. 7- Shepherd, J. L., Lane, D. J., Tapscott, R. L., & Gentile, D. A. (2011). Susceptible to Social Influence: Risky “Driving” in Response to Peer Pressure. Journal of Applied Social Psychology, 41(4), 773-797.
In 2010, road traffic injuries (RTIs) are the leading cause of deaths in those aged 1-19 years globally and half of those victims are vulnerable road users (VRUs), defined as pedestrians, bicyclists and motorcyclists. Low-income countries account for the highest proportion of VRU deaths. The change in distribution of the burden of RTI during recent decades is unclear. To highlight changes over time in RTI mortality among children and adolescents VRU and non-VRU globally, by region, and by country income level between 1990 and 2013. Country-level data were extracted from the global burden of disease study, split into seven geographical regions and four income levels (low-income [LICs], lower-middle [LMICs], upper-middle [UMICs] and high-income [HICs]). Mortality rates for 1990 and 2013 were calculated considering in turn all categories of road users aggregated, VRUs and non-VRUs. For all road users aggregated, at country level RTI mortality rates decreased sharply within each country income level and each region between 1990 and 2013, but an increase of 21% was found in LMICs of Sub Saharan Africa (SSA). Mortality rates for VRUs and nVRUs also decreased remarkably except among non-VRUs from LICs where the mortality rates increased by 16%. For VRUs, the reduction in mortality rates was more than twice as high in HICs (58%) and LICs (43%) than in UMICs (20%) or LMICs (23%). Considering country income level within regions revealed increased mortality rates for non-VRUs in LICs of South Asia by (26%) and for both non-VRUs (5%) and VRUs (35%) in the LMICs of SSA There have been considerable reductions in RTI mortality rates globally and by region of the world since 1990. While there is a need for enhanced RTI prevention globally, these findings call for the intensification of preventative efforts in specific parts of the world.
Introduction/Problem statement In 2007, road safety was assessed as one of the more serious safety risks in Ras Laffan Industrial City (RLIC). It accounted for 1,540 road traffic crashes, one fatality, several serious injuries and a number of property damages during the year. As a result a committee was formed which included all stakeholders in the Industrial City to set achievable and sustainable goals to reduce the road safety risk rate to “As Low as Reasonable Practical” (ALARP). The committee developed and implemented a sustainable road safety program, holding all persons entering RLIC responsible for contributing to a new safety culture. The aim was to reduce road related crashes by at least 20% per annum. Methods 1. The committee conducted an ALARP road safety study to identify and analyze the highest road safety related risks in all common road and concession areas of the Industrial City and established mitigation measures for each risk identified to prevent death, serious injury or property damage. 2. Investigated the root causes of road traffic crashes and classified them in categories that include human behaviour, road engineering, vehicle fitness, driver fitness and environmental conditions such as dust and fog. 3. Developed and implemented sustainable mitigation measures for each of the categories identified. 4. Developed and implemented a road crash database to record and track crash data. Throughout this process focus was given to incident investigation, statistical analysis, end users involvement, awareness campaigns, alternative transport modes, speed enforcement, radar monitoring systems, audits, inspections of road network and systems, community outreach programs, education and enforcement. Results As a result a high-level awareness road safety “Zero Tolerance Visibility Program” was introduced with input from the local traffic department, business partners and industry road safety experts. Between 2007 and 2014, road traffic crashes were reduced by 85% cumulatively. The strategies proved to be successful by: (1) the reduction in fatalities from one fatality in 2007 to zero fatalities during the period of 2008 to 2014; and (2) a notable reduction in road traffic crashes from 1,540 in 2007 to 278 in 2014. Conclusions Overall the Zero Tolerance Visibility Program implemented during 2007 yielded positive results. With continuous improvement of the vision for safer roads, further reductions in road traffic crashes will be achievable. Furthermore, these strategies may also be suitable for application in other workplaces similar to Ras Laffan Industrial areas.
Road deaths and injuries are increasing in India due to unprecedented motorization and expansion of infrastructure amidst absence of strong road safety policies and programmes. In 2014, 141,000 persons died and 4,77,731 persons were injured as per official reports (1). However, data from World Health Organization, Global Burden of Disease 2013 and independent Indian studies estimate these numbers to be much higher due to underreporting of Road Traffic Injuries (RTIs). Nearly 10-30% of hospital registrations are due to RTIs and majority of them are discharged with varying levels of disabilities. Individuals in the age group of 15-44 years, men and, middle and poorer sections of society are affected most in RTIs. Pedestrians, motorcycle riders / pillions and bicyclists, the vulnerable road users, are killed and disabled in large numbers. The economic losses from road crashes are estimated to be 3% of GDP and are increasing from year to year (2). Amidst significant regional variations, many Indian states have road deaths much above the national average. Indian states that have progressed in development, infrastructure, education and per capita incomes also have the highest rates. While urban deaths account for nearly a fifth of total deaths and injuries, Indian highways account for more than 50% of deaths and injuries and are likely to increase with further growth in infrastructure (1). This distribution clearly implies that transport and mobility growth should be accompanied by road safety as well. Road crashes occur due to a complex interaction of human, vehicle and environmental factors in heterogeneous transport environments. Despite the growing number of crashes, the understanding of road crashes in India has been limited. All official reports till date indicate ‘human error, driver negligence, rash driving, careless driving’ as the major cause, thereby implicating human behaviour to a larger extent. However, independent limited research in recent years has informed that several issues in road environment, vehicle safety, behaviour of road users, enforcement of safety laws, availability and affordability of trauma care and others are responsible for both causation and poor outcomes in road crashes (3). Most glaringly, the absence of an efficient road safety management system has resulted in piecemeal and fragmented solutions. Many high-income countries implemented systematic interventions based on a scientific understanding of road safety (Haddon’s matrix, safe systems approach, public health understanding, and others) and successfully demonstrated that road crashes are predictable and preventable (4). As the causes for road crashes are multiple, interventions need to be several and needs prioritisation in India. Road safety management through a clearly defined road safety policy, a central coordinating agency to guide-coordinate-monitor-direct-implement and evaluate activities, improving human/financial/ physical resources are urgently required to develop a road map for future activities. Safe infrastructure development through low cost and sustainable engineering solutions that are geared for people’s needs and travel patterns addressing both mobility and safety is critical. Vehicle safety that adheres to safety standards is vital to make people safer. Strict implementation of proven and effective interventions (e.g., helmets and safety belt laws, drink drive laws, speed control measures, and visibility related measures) are required to make people safe and reduce poor outcomes. Good trauma care practices that include rehabilitation services are highly essential to save the injured. Undoubtedly, all these activities need to be driven by evidence based practices and data driven systems. As road safety is the shared responsibility of different ministries and departments at this time, it requires participation from health and all other sectors to develop integrated, intersectoral and coordinated approaches (5). References: 1.National Crime Records Bureau. Accidental deaths and suicides in India 2014. Ministry of Home Affairs, Government of India, New Delhi, 2015 2.Gururaj G. Road safety in India- A framework for action. Publication No. 83, National Institute of Mental Health and Neuro Sciences, Bangalore, 2012 3.Gururaj G and Bangalore Injury Surveillance Collaborators Group. Bangalore Road Safety and Injury Prevention Program: Results and Learning, Publication no 81, National Institute of Mental Health and Neuro Sciences, Bangalore, 2011 4.World Health Organization. Global status Report on Road Safety, Geneva, 2013 5.World Health Organization .Global plan for the Decade of Action for Road Safety 2011 – 20, http://www.who.int/roadsafety/decade_of_action/plan/plan_english.pdf?ua=1, accessed on 28th July 2015
Injuries and fatalities occur in all forms of transportation. Numerically, road traffic accidents account for the great majority worldwide. Special questions (especially from the forensic medical point of view) are associated with maritime and flight crashes, when bodies are heavily mutilated and severely decomposed (concerning i. e. identification). – Post mortem radiological investigations are of special value (especially body scanning, pm CT, so called virtual autopsy). The pattern of injuries, toxicological findings, and trace evidence vary considerably and the whole scale of forensic medical analyses is required. This concerns for example: Pattern of injury of vehicle occupants, effect of seatbelts, vulnerability of children in vehicles, injuries to motorcyclists, pedal cyclists and pedestrians, cause of death, suicide and homicide, railway injuries and the special dynamics of other motorized transports. Concerning fitness to drive/pilot/navigate/work careful medical (i.e. concerning epilepsy), psychological (concerning psychiatric illness, substance abuse) and toxicological screenings and investigations are required. For example chronic alcoholism and drug dependence have to be evaluated (i.e. by segmented hair analysis). Such drivers are responsible for very severe crashes. According to the German law these persons are banned from driving motorized vehicles.
Young driver overrepresentation in road crash deaths and injuries is observed worldwide including Qatar. Multiple independent factors contribute to this high risk including age, brain development and inexperience. These factors also explain young drivers' high level deliberate risk taking behaviors including speeding. A Graduate licensing scheme (GLS) which requires new drivers to pass through multiple licensing stages (each with specific restrictions) before obtaining a full license is utilized in many countries to manage the risks of these drivers coming out of constrained learner license conditions (e.g. Australia, USA, Canada, South Africa, United Kingdom). For example, in the state of New South Wales (NSW), Australia, drivers are required to go through three licensing stages?Learner license for at least 12 months, provisional P1 license for at least 12 months, and provisional P2 license for at least 24 months. Specific restrictions apply at each license stage (e.g. Learners to observe a maximum speed limit of 80 km/h; P1 a maximum of 90km/h; P2 a maximum of 100km/h) in addition to the NSW Road Rules which apply for all license holders. The successes of GLS in reducing crash risks have been demonstrated in multiple evaluations. In July 2007 NSW introduced additional license conditions for P1 drivers including automatic license suspension if caught for any level of speeding. This tougher penalty for speeding is intended to increase deterrence for speeding and for novice drivers based on evidence of young driver over-representation in serious speed related crashes. This change brought about a 34% reduction in deaths involving novice drivers. It is recommended that GLS be implemented in Qatar with tightened license conditions for novice drivers to address the young driver serious crashes in Qatar.
Not being able to drive your own car can be devastating for mobility, health, finances and self-esteem. Driving is a visually demanding task (Owsley et al., 2008) and insufficient visual field can lead to revoked license. Acquired brain damage can impair the visual field and stroke is a very common diagnosis among drivers with visual field defects. de Haan et al. (2015) identified several undocumented difficulties among patients with homonymous visual field defects. License holders with visual field defects and interested in being assessed in a driving simulator were invited to answer a short web questionnaire. During the period December 2013 to June 2015, close to 400 people responded. The group is however not representative for the population of drivers with visual filed defects. Instead, it comprise the subgroup that is most concerned to get a new driver license issued (or to keep the license if it not yet withdrawn). A vast majority in the studied group was men (83 %). Almost 3 out of 4 were aged 55 years or more. The three most common diagnosis were stroke (39 %), glaucoma (31 %) and diabetes (13 %). General health status, vision and driving ability was self-estimated as very good or relatively good by 90-95 % of the respondents on a 5-grade scale. Weekly distance driven was estimated to 200 km (median). Involvement in accidents with only property damage, near-accidents and personal injury accidents during the period 2008-2013 was experienced by 8 %, 5 % and 1 %, respectively. Drivers with visual field defects regard themselves as healthy and good drivers. The drivers do often not understand the withdrawal of the driving license; many comments that they had driven for many years without any problems and that they can compensate for the defect by head movements. References: Owsley, C., Wood, J., McGwin, G, (2008). A roadmap for interpreting the literature on vision and driving. Survey of Ophthalmology, Volume 60, Issue 3, May–June 2015, Pages 250–262. de Haan, G A., Heutink, J, Mellis-Dankers, B., Brouwer W H, Tucha O. (2015) Difficulties in Daily Life Reported by Patients With Homonymous Visual Field Defects. Journal of neuro-ophthalmology: the official journal of the North American Neuro-Ophthalmology Society.
Qatar is one of the 20 countries of the IDF MENA region. Three hundred and eighty seven million people have diabetes worldwide and more than 37 million people in the MENA Region; by 2035 this will rise to 68 million. There were 303,700 cases of diabetes in Qatar in 2014. Large number of diabetic patients will seek or currently hold a license to drive. Most of these patients are either on oral medications or insulin to control their diabetes. Hypoglycemia is one of the major complications related to diabetes treatment. Many large studies have shown an increased risk of hypoglycemia with tight blood sugar control. Unfortunately most diabetes medication can cause hypoglycemia. Hypoglycemia has been associated with cardiac arrhythmia, a decreased ability to drive and driving mishap. Recent meta-analysis of 15 studies showed a risk road traffic collisions (RTC) of 12-19% greater than general populations. The most significant subgroup of persons with diabetes is those on insulin therapy. The single most significant factor associated with RTC appears to be history of recent severe hypoglycemia. Government regulations have not been established in most of GSC and MENA in general. All EU countries do have regulations for diabetes and driving. Many US states have a restrictive license program for drivers with medical conditions including diabetes. These regulations include more frequent medical examination to denial of driving license, e.g.in those patients with hypoglycemia unawareness. Also more restriction regulations have been established for drivers who are using insulin and buses and heavy goods trucks.
Traffic safety is one of the most important means to protect human life as well as personal and public property from harm and to contribute to social and economic growth and development. Several factors have been linked to traffic safety, but the most prominent ones are: the driver, the vehicle and the road. This paper, however, focusses only on the driver as an essential factor that impacts others, and analyzes the driver’s behavior and how drug use and psychoactive substances relate to road accidents and traffic safety. On the one hand, official statistics in the Kingdom of Saudi Arabia reveal that up to 2014, traffic accidents had increased by %400 in the previous ten years, and in the past 23 years more than half a million people were injured and sixty thousand died. This represents an annual average of 4200 deaths, 1200 permanent disabilities and 8000 temporary disabilities. On the other hand, official statistics in the Kingdom of Saudi Arabia point out to a-ten-fold increase in the previous years in the use of drugs and psychoactive substances. In 1980, drug cases were in the range of three thousand, but today there are more than 40,000 annually, %70 of which concern drug consumption. Since traffic safety requires that drivers observe a high degree of vigilance and caution in order to cope with road conditions, scientific studies indicate that drivers under the effect of narcotics and psychoactive substances lose the ability to deal with unexpected emergencies. They lose the ability to concentrate and they suffer from disequilibrium in perceiving road turns and intersections and slow eye response to light, among other factors. Owing to the fact that traffic safety is vital in safeguarding society, human life and economic resources, it is essential to study the relationship between traffic accidents and the driver's behavior under the effect of narcotics and psychoactive substances. This relationship should be examined in a profound and scientific way to enable us to take appropriate decisions and offer practical solutions and to ensure road safety. This paper addresses three issues: the size and type of traffic accidents in relation to the driver’s behavior, the size and type of traffic accidents related to the behavior of the driver under the influence of narcotics and psychoactive substances, and the practical solutions for these problems with a view to achieving the right to traffic safety for all.
Ambulance use in low-and middle-income countries is very low. This study assesses characteristics of road traffic injury (RTI) victims coming to emergency departments (EDs) by ambulance and compares with RTI victims coming via alternative modes of transportation. The Pakistan National Emergency Departments Surveillance (Pak-NEDS) was a surveillance conducted in seven major tertiary-care EDs in six main cities of Pakistan from November 2010-March 2011. Univariate and multivariate logistic regression was carried out to investigate the factors associated with ambulance use in RTI patients. The variables used for regression gender, age groups, cities, hospital type, road user type and disposition. There were four age categories; ≤18 years, 19 -45 years, 45 – R years and ≥65 years. RTI patients were divided into two road-user groups; VRUs (pedestrian, motorcycle driver and passenger, bicyclists) and non-vulnerable road-users (non-VRUs) including four-wheel vehicles’ driver and passengers. Level of significance was set at 0.05. Ethical approval was obtained at all participating sites. Pak-NEDS enrolled 9769 RTI patients. The mode of arrival was known for 92.2% (n=9009) RTI patients, of which 9.1%(n=821) were brought to the ED by ambulance. The mean age was higher in the ambulance group (33.3±16.9 versus 28.8±14.1 years, p-value <0.001). The most common road-user in the ambulance group was motorcycle drivers (n=201,24.5%) and pedestrians (n=3131,38.2%) in the non-ambulance group. Head and neck injuries (n=240,32.9%) in ambulance and upper limb injuries (n=2470, 34.3%) in non-ambulance group were common. There were 3.7% (n=23) deaths in the ambulance group and only 0.6% (n=38) in the non-ambulance group. Patients of all age groups were more likely to use ambulance compared to those >65 years of age (p-value<0.001) adjusted for gender, cities, hospital type, road use type and disposition. The adjusted odds ratio of utilizing ambulances for VRUs was 1.3 times higher than non-VRUs (p-value0.008). Although the overall use of ambulance for RTI patients is very low in Pakistan, however, we found that RTI patients who used ambulance were more likely to be younger and VRUs. Majority of these patients had suffered from head and neck injuries and were more likely to die in the ED.
Effective injury mitigation measures can only be developed once a clear understanding of the problem has been obtained. The factors which contribute to the problem and hence the solution are based of analysis of real world data. The incidence of spinal injuries in traffic accidents has been identified to be a significant problem in Saudi Arabia and Gulf Countries (GCC). However, a detailed database, which could offer data from real world accidents, does not exist in this region from the world. Thus, the main aim of this study is to develop a sufficiently in-depth database, which can then be interrogated to address the problem of spinal injuries in Saudi Arabia. In this study, data on 778 spinal injuries (AIS ≥ 2) sustained by 552 casualties in 512 vehicle crashes collected from the city of Riyadh has been discussed and analysed. The primary crash factors, which might influence the occurrence and severity of spinal injuries, have been examined. In conclusion, the results obtained by this study can contribute significantly towards understanding the cause of spinal injuries and coming up with safety measures to mitigate them, especially in Saudi Arabia.
Road traffic injuries (RTI) are the leading cause of death in Qatar with one in eight deaths from all causes due to RTIs. Furthermore, motor vehicle crashes (MVC) are becoming a growing public health problem and the use of seatbelt is universally low throughout the nation. The aim of our study was to investigate and highlight potential socio-demographic risk factors that contribute to seatbelt non-compliance. A prospective cross-sectional survey of all adults admitted with orthopaedic injuries following a MVC was conducted. A physician-administered questionnaire was used to interview all patients. Univariate and multivariate logistic regression analysis was carried out to examine the association of various risk factors and seatbelt compliance. One hundred and seventy one patients were interviewed over a twelve-month period. Of the 171 patients, 103 patients (60%) (92 males, 11 females) were not wearing a seatbelt compared to 68 patients (59 males, 8 females) wearing a seatbelt. The mean age of the non-compliant patients was 32.8 years compared to 33.8 years of the compliant patients. Seatbelt compliance was associated with gender (OR: 11.3), nationality (ORs: 7.6 and 1.9), position in the car (OR: 14.2), education of the patient (ORs: 25.9 and 30.5), time of the injury (OR: 3.3), marital status (OR: 6.5), awareness of seatbelt campaign (OR: 5.9) and owner of a vehicle (OR: 11.2). The majority of non-compliant patients were single males from a Middle Eastern background that we involved in a MVC during the weekend. The majority of patients admitted with orthopaedic injuries following MVCs were not wearing seatbelts. The majority of non-compliant patients were driving 4WD vehicles and had crashes on main roads. A further national seatbelt campaign is required to promote the importance of seatbelt compliance amongst young male drivers with more stringent traffic penalties.
Backgrounds: Pre-hospital emergency call is a crucial index to indicate emergency disease spectrum. For Beijing, which has changed greatly in economy and population, analyzing the trend of the emergency disease spectrum can greatly contribute to formulate the pre-hospital emergency planning. Methods: In this 10-year retrospective study, pre-hospital emergency records of Beijing Emergency Medical Center from 2003 to 2012 were collected. Medical Priority Dispatch System was used to classify the call demands. Linear regression models were constructed to examine the changing trends. Results: 2,410,575 cases were collected, and 2,278,415 of them were analyzed in this study. The results showed that: 1. In the past decade, the number of pre-hospital emergency call demands soared from 150,656 to 309,297 (204.6%, 2012/ 2003, p<0.001). 2. The top five call demands based on the rank of proportion were trauma related demands(25.4%, including falls（5.0%）, traffic/ transportation incidents(7.2%) and traumatic injuries(13.1%)), sick person(17.7%), heart problems(11.4%), unconscious/fainting（10.0%） and breathing problems（8.1%）Also, they were the top five fastest growing call demands. Conclusion: Compared with the growth of population (145.4%, 2012/2003), pre-hospital emergency calls increased much more, which shows a growing desire on ambulance service. Different from developed countries, the proportion of trauma related cases was constantly in the top rank and continuously increasing, much higher than that in San Francisco (15.7%), which could be resulted from accelerated city construction and rapid augment of vehicle quantity(244.8%, 2012/ 2003). Based on the changes and trends of pre-hospital emergency disease spectrum, it is encouraged to provide specific training program for emergency medical service staff and improve related medical devices. Note: Beijing emergency medical center is the only pre-hospital emergency system of Beijing government
