Background: The huge number of road traffic crashes (RTCs) resulting in death, disability or injury renders road safety a crucial issue worldwide. Nevertheless, most of the available literature focus on the pre-RTC factors rather than the post-crash period. As a result, little is known about the physical and mental burden following a RTC. The aim of this scoping review was to summarize the evidence on the factors associated with the long-term consequences on physical and mental health of individuals involved in RTCs. Method: Long-term consequences, physical and mental health, quality of life, road traffic crash were some of the keywords used to search the PubMed, Scopus, and Web of Science electronic databases. Eligible studies were observational, published between 2010 and 2024, investigating the physical and mental long-term consequences of RTCs on any type of road users. Results: Starting from 419 papers and following the PRISMA 2020 guidelines, 50 studies were recorded as relevant. After reading the full text and retrieving two further articles through citation searching, 35 studies were included in this review. Findings showed that variables associated with the long-term consequences on physical and mental health can be categorized into demographic, clinical, psychological, socioeconomic, and crash-related factors. When distinguishing among road user types, cyclists showed better health outcomes compared to other groups. Conclusions: This scoping review focuses on the long-term physical and psychological impact that RTCs have on individuals, emphasizing the need to regard recovery as an extended and multidimensional process. Methodological heterogeneity across studies limits comparability, thus underscoring the need for standardized measures and consistent follow-up periods in future research. Practical applications: These findings carry important implications for clinical care and public health and highlight the importance of identifying individuals at risk of unfavorable long-term consequences and implementing coordinated approaches that encompass both physical and psychological aspects.

Introduction Despite advancements in emergency care and prevention, many road traffic crash (RTC) survivors suffer from enduring impairments that are insufficiently considered and registered in hospital records or existing surveillance systems. Building upon evidence from prior initiatives [1-3], this study aims to (1) assess the multidimensional long-term outcomes of RTCs, (2) identify early predictors of functional and psychological recovery, and (3) inform data-driven strategies for post-injury rehabilitation and health system planning. Aim The ProtAct-Us from Long-Term Consequences of Road Crashes (ProtAct-Us), a project funded by the European Union, addresses a critical, yet often underexplored, multidimensional aspect of road safety: the long-term consequences of road traffic crashes (RTCs) on individuals' physical, cognitive, psychological, and socio-economic well-being. Methods This multicentre, prospective, observational longitudinal study will be conducted across Germany, Greece, and Italy. The study population comprises adults (≥18 years) involved in RTCs, enrolled through hospitals, trauma centres, or on the accident scene from June to December 2025. Consecutive sampling will be performed until the minimum required sample size of 120 subjects is collected. Informed consent will be obtained in compliance with national regulations. Data will be collected at two timepoints: baseline (within 30 days after the accident) and 12 months post-injury. Validated instruments will be used, covering health-related quality of life (EQ-5D), cognitive function (MoCA), psychological status (CES-D, IES-R), social support (MOS), and economic burden (Muarc). Variables related to injury characteristics, health history, and contextual factors (e.g. access to care, social and work reintegration) will also be recorded. Statistical Analysis Descriptive analyses will summarise the sample's clinical, psychological, and socio-demographic features. Recovery trajectories and outcome prevalence at 12 months will be analyzed. Univariate analyses will explore associations between potential predictors and outcomes. Multivariate regression will identify independent predictors of poor recovery, such as persistent pain, psychological distress, or reduced participation in the daily activities. Conclusion By integrating medical, psychological, cognitive, and socio-economic data, the ProtAct-Us study will try to provide a comprehensive understanding of the long-term burden of RTCs. This multidimensional approach is expected to generate evidence-based recommendations to improve recovery pathways, tailor rehabilitation programs, and enhance policy responses. Findings will contribute to a more person-centred and sustainable management of the road traffic injury consequences for all road traffic users. Findings from ProtAct-Us will contribute to evidence-based public health and policy-making by quantifying the long-term burden of RTCs and identifying modifiable risk factors, ultimately supporting more effective post-crash care strategies.

Introduction The considerable number of road crashes resulting in death, injury and disability makes road safety a crucial issue worldwide [1], [2]. Preventing road deaths, addressing severe injuries in road traffic and their long-term effects, both mental and physical, remains a critical aspect of achieving a resilient and future-proof transportation system. Aims To summarize findings from longitudinal studies on mental health, psychological outcomes, and mental health-related quality of life (HRQoL) following road traffic crashes (RTCs) in order to suggest implications to improve recovery and rehabilitation. Methods Long-term consequences (LTCs), physical and mental health, quality of life, and road traffic crash were the keywords used to search the PubMed, Scopus, and Web of Science electronic databases. The initial search yielded 420 records, reduced to 390 after the removal of duplicates. Following the PRISMA 2020 guidelines, 50 observational studies published between 2010 and 2024 were identified as relevant, and one was found through citation searching. At the full-text reading 17 papers were excluded. As a result, 34 articles were included in the review. These studies investigated the long-term physical and psychological consequences of road crashes across all categories of adult road users. Seven papers showed a specific focus on mental health outcomes, including post-traumatic stress syndrome, pain-related psychological distress, depressive symptoms, mental HRQoL, and cognitive impairment. Results The reviewed studies consistently show that RTCs can lead to substantial long-term mental health consequences. A considerable number of individuals experience post-traumatic stress symptoms, with higher rates observed among those with more severe injuries. Persistent pain and residual physical or psychological symptoms are common even several months after the crash, often impairing daily functions and delaying return to work. Depression and anxiety symptoms are associated with slower recovery, and negative expectations about recovery strongly predict persistent pain and emotional distress over time. Mental HRQoL, measured by means of standardized instruments, generally improves within the first year after the crash, but often remains below pre-injury levels, especially among those with longer hospital stays or more severe injuries. Sociodemographic and clinical factors such as female sex, middle age, higher injury severity, and low physical or mental HRQoL scores are significantly associated with poorer mental health outcomes. In contrast, higher education levels, better physical functioning, and protective behaviors (such as the use of safety equipment) are associated with improved mental recovery and reintegration into daily life and work. Overall, these findings highlight the need for targeted mental health screening and supportive interventions in the post-injury care of RTC survivors. Characteristics of the included studies are summarized in Table 1. Conclusions This review emphasizes the importance of early psychological screening, targeted intervention, and policy efforts to mitigate the mental health burden among RTC survivors.

Abstract Battling serious injuries and long-term consequences in road traffic remains one important issue in the overall goal of resilient future road transport and its Vision Zero. Challenges of increasing personal transport in urban areas coupled with autonomous vehicles and shuttles, new mobility devices and the overall need to ensure the safety of vulnerable road users as well as all types of vehicle occupants’ require solid medical background knowledge paired with innovative engineering approaches. EU Horizon Europe is currently funding the ProtAct-Us consortium (2024-2027) that aims at protecting all Road User Groups from serious injury and long-term physical, cognitive and mental health consequences related to road crashes through innovatively interlinked research action between medical and engineering methods and approaches. ProtAct-Us works on the following goals and challenges: i) Medical data correlation, standardisation and classification of long-term consequences of road crashes; ii) Robust and reliable medical, epidemiological and engineering tools like agreed methods to collect information on long-term consequences, upgraded Human Body Models and virtual assessment methods for the extremities, head, neck and face allowing for effective countermeasure development for all road users; iii) Reduction of long-term consequences and related socio-economic cost of road crash related injuries for all road users. The ProtAct-Us solutions will influence new standards in respect of extending current injury codification system with relevant long-term aspects, allowing new physical as well as virtual safety assessment procedures and adaption of rules and regulations to be implemented. Finally, scientifically well-founded suggestion for future implementation into policy, regulatory, and standardization guidelines for an inclusive safety improvement approach for in- as well as post-crash will be provided.

Several studies have shown how mental health could be affected during the COVID-19 pandemic, which led us to wonder about the psychological impact that the initial period of lockdown could have. We conducted a multicentric study that sought to describe, compare, and analyze the association between perceived stress, coping strategies and sociodemographic characteristics in a snowball-style convenience sample of 1169 participants from Colombia, Brazil, Mexico, Italy, and Spain who responded to an online survey. There were differences in perceived stress and coping strategies between countries and depending on sociodemographic characteristics. The variables positively associated with perceived stress were the coping strategies alcohol-drug use, focus on emotions and venting, being a woman, and living in Brazil, Italy, and Spain. The variables negatively associated with perceived stress were planning and active coping, positive reinterpretation, being over 45 years old, and being a worker. These results contribute to understanding the stress responses to lockdown and help identify vulnerability factors in order to design prevention and intervention programs. Keywords: Perceived stress; coping strategies; COVID-19; lockdown; pandemic.

The increasing demand for renewable energy production entails the development of novel green technologies, among them the use of biomass for energy generation. Industrial processes raise new issues regarding emerging risks for the health of people working in biogas plants and of nearby communities. The potential epidemiological and environmental impacts on human health related to biogas plants were assessed by means of a review of the available literature. Nineteen papers published between 2000 and 2022 were identified through electronic database search using search strings. The selected works are epidemiological studies and environmental monitoring studies, which aimed at investigating what are the health risk factors for biogas plant workers and for people living in the surrounding communities. The results of the epidemiological studies revealed a potential exposure to endotoxins and fungi that are associated with respiratory symptoms. Furthermore, the results from the environmental monitoring studies showed significant concentrations of particulate matter, microbial agents, endotoxins, and VOCs in occupational settings. In conclusion, the results of this literature review suggest that further analyses through an integrated approach combining environmental and health data are necessary for a comprehensive understanding of the potential risks associated with the uptake of biogas technology.

SUMMARY:Professional exposure to benzene has been extensively investigated by occupational medicine, leading to strict regulation of exposure threshold values. However, the petrochemical industry utilizes many chemical substances, whose exposure, without effective control and mitigation actions, could influence the health status over time. The aim of this narrative review is to describe health status of petrochemical workers related to occupational exposures, inquiring literature from 1980 to present. We used the PubMed and Web of Science search engines. As regards non-neoplastic diseases, despite heterogeneous prevalence estimates, we could say that standardized mortality rate (SMR) for hypertension, hypercholesterolemia and diabetes does not increase overall, compared to reference populations; a possible explanation may be the "healthy worker effect". Attention should be paid to color disperception and respiratory symptoms, due to toxic or irritating substances exposure. Studies concerning neoplastic pathology have mainly investigated mortality outcomes, finding no increase in cancer, except for melanoma or other skin cancers and leukemia. As regards the former, however, it is not excluded that other risk factors may contribute (e.g. UV rays in offshore workers), while for leukemia, only the most recent studies have analyzed various subtypes of hematopoietic tumors, highlighting a possible risk for the development of myelodysplastic syndrome. The risk of pleural mesothelioma was also increased, likely due to asbestos exposures, while the risk of death from prostate cancer remains controversial.

Introduction. As part of the holistic concept of health, mental health can be focused on prevention of contagion and coping with the disease and its consequences in the context of the current COVID-19 pandemic. The present study describes, compares, and analyzes the association of the impact of the event, perceived stress, coping strategies, emotional regulation, and sociodemographic characteristics during the quarantine in various countries. Material and methods. This research is a multicentric and epidemiological study with a convenience online snowball sampling of the general population and university students. Results. 1.179 participants from Colombia, Brazil, Mexico, Italy, and Spain responded to the survey. Most of them included students and workers, with a high educational level and living with family during the quarantine. There are significant differences in the medians of all variables among countries and sociodemographic characteristics. The variables positively and significantly associated with the impact of the event during quarantine included the perceived stress, the coping strategies of alcohol/drug use, planning and active coping, focus on emotions and vent, the emotional regulation strategy expressive suppression, and living in Italy. Conclusions. These results have contributed to the understanding of mental, emotional, and behavioral response to quarantine, as well as underline the urgency of monitoring mental health among the vulnerable groups, in order to design specific prevention and intervention programs.

Introduction. In the current COVID-19 pandemic governments and health entities urgently responded to the biological threat developing diagnostic tests, treatments, vaccines, additionally the economic concerns were approached, however there is little effort directed to the mental health, which is part of the holistic concept of health, and from where interventions for the prevention of contagion and coping with the disease and its consequences can be focused. The present study sought to describe, compare, and analyze the association of the perceived stress, coping strategies, emotional regulation, hopelessness, impact of the event, psychological distress, suicidality, as components of mental health, and sociodemographic characteristics during the quarantine in various countries in Europe and Latin America. Material and methods. Multicentric and epidemiological study approved by the Ethics Committee of the Universidad Cooperativa de Colombia. Convenience online snowball sampling of general population and university students. The questionnaire contained the informed consent, sociodemographic data, and the Impact of Event Scale-Revised, Perceived Stress Scale, Coping Orientations to Problems Experienced, Emotion Regulation Questionnaire, Symptom Check-List-90 Revised, Beck's Hopelessness Scale, and Okasha Suicidality Scale. Data were collected between April and June 2020. Statistical analysis: Internal consistency of scales was estimated by Cronbach's alpha. Normality of distribution was assessed by Kolmogorov-Smirnov tests. Univariate (Kruskal-Wallis test, Spearman correlation) and multivariate analyses (Generalized Linear Models) were performed using STATA 16. Results. 1.179 participants (27.48% male) aged between 15 to 76 years (M=33.52, SD=13.4) from Colombia (N=356), Brazil (N=364), Mexico (N=202), Italy (N=166), and Spain (N=91). The majority are students and workers, whit high level of education, and living with family during the quarantine. There are significant differences in the medians of all variables among countries and sociodemographic characteristics showing greater psychological affectation in young people, students, women, and inhabitants of Brazil, Italy and Spain. Most variables correlate with each other in a statistically significant way as theoretically expected. Conclusions. Due to the complexity of the pandemic, there are differences in terms of contagion containment measures, restrictions, laws and sanctions, government and health authorities’ management, type of information disseminated by media, resources available for diagnoses, treatments and aid, number of infections and deaths, job and economic losses, that significantly affect the impact in mental health worldwide. The results of the present research contribute to the understanding of mental, emotional and behavioral reactions of people across different countries and according to sociodemographic characteristics and underline the urgency of monitoring mental health in vulnerable groups, in order to design specific prevention and intervention programs.

To improve the safety of bicycle users, some countries have enacted, or considered enacting, mandatory helmet legislation. Of course, the enactment of such legislation in a country assumes that its citizens will be well-informed of it, and consequently, will use the helmet more frequently than before. However, in the survey described in this paper we found that many people are not aware of the legislation in force in their own country, or, even if they know, they may not necessarily behave as dictated by the law. Thus, the effects of mandatory helmet legislation may be somewhat different than desired or expected. Therefore, the goal of this paper is to ascertain the role of cyclists' knowledge of the law in their country as a mediator between the law and the actual use of the helmet. Respondents from seventeen countries participated in an international survey about cyclists' habits, and answered questions about helmet legislation, and frequency of helmet use. The results indicate that the main effect of mandatory helmet legislation on the frequency of use of the helmet is mediated by the perception that such a law exists in their country-even when in fact sometimes it does not exist. (C) 2020 Elsevier Ltd. All rights reserved.

Abstract Background The current paper is part of the EU-funded REHABILAID Project and aims to describe the profile of cyclists sustaining severe injuries in a road traffic incident as well as the healthcare costs associated with their injury, including hospitalization costs and out-of-pocket expenditure. Methods Seven public hospitals were involved; Greece=5, Italy=1 and Germany=1. Both the intensive care units (ICU) and sub-intensive care units (as high-dependency areas) were involved. Participants enrolled during a 12-month period starting from April 2013 and were followed for one year from admission date. The study used widely recommended classifications for injury severity (AIS-Update 2008, MAIS). Information on the injury was retrieved upon patients’ consent, from medical records while interviews were carried out at months 1,6,12 for personal and cost-related information. Health Care Expenditure was assessed through the MUARC’s framework. Diagnosis-related groups (DRGs) were used to estimate hospitalization costs. Results 120 subjects enrolled in the study in total and 14 were cyclists(Greece=1, Germany=3, Italy=10). Most of them were men(n = 9, 64.3%), with a mean age of 55.5 years (SD16.3;min 32-max 84). As for the current incidents, the majority occurred at city roads (n = 10;71.4%), straight roads (n = 9;64.3%) and intersections (n = 3;21.4%). Many were single-vehicle (n = 4;28.6%), lateral (n = 4;28.6%) and front-lateral (n = 3;21.4%). Half of the cyclists sustained an injury of MAIS3+ severity (n = 7;50.0%). A major injury was primarily sustained at the lower extremities (n = 10;71.4%), head (n = 7;50.0%), face (5=35.7%) and upper extremities (n = 5;35.7%). The mean total hospitalization cost was 5815,6(min 209,00-max 20.647,00) and the mean direct costs arising from injury was 4.047,5(min 0,0-max 24.670,00). Conclusions Individual differences need to be taken into account in future injury prevention efforts as well as in attempts to improve healthcare system’s response to road victims. Key messages Systematic collection of data relevant to health condition and economics of the victims is necessary at European level. Personalized rehabilitation plans are necessary to facilitate the recovery process of victims.

Biking is a means of sustainable transport and is expected to grow over the next few years. Cyclists are more vulnerable road users than car, bus, and truck drivers. This is a pilot study aimed at generating information on the use of bike safety equipment and high-visibility clothing among Italian adult cyclists and identifying factors associated with safety gear use. Data from a European study involving a web survey of 2,470 cyclists were analyzed. The sample was composed of 62% males, the sample median age was 54, and the proportion of those using a city bike was about 72%. The association between individual and bike characteristics and the use of bicycle safety equipment-light and reflectors-and high-visibility clothing were studied with regression logistic models. The results showed that cyclists who use conspicuous clothing were males, older, came from the South, rode more than 60 km, and used bike safety devices. Riders who used all or at least one item of safety gear rode city bikes and used high-visibility clothing. The data provided a first step in filling the gap in knowledge concerning individual-based safety measures and bike safety equipment use in Italy.

This study examines beliefs about helmet use in adult cyclists from 17 countries participating in the COST Action TU1101 Project (Helmet Optimization in Europe - HOPE). A total of 5797 respondents were included in the analysis after applying eligibility criteria and data cleaning. Cyclists' beliefs were assessed by 25 items using a 7-point Likert scale. These items were factor analyzed resulting in a four-factor solution (Factor 1: Perceived Benefits and Risk Reduction, Factor 2: Perceived Disadvantages and Barriers to Helmet Use, Factor 3: Perception of Group Norms, and Factor 4: Situation-Dependence of Helmet Use). Results show that both beliefs and helmet wearing behavior differ according to some demographic and cycling-related factors, such as gender, frequency of bicycle use and type of bicycle used. Factor 3 (Perception of Group Norms) and Factor 2 (Perceived Disadvantages and Barriers to Helmet Use) were among the strongest predictors of helmet use, even after controlling for demographic and cycling-related variables. The findings suggest that helmet use promotion should focus primarily on normative beliefs and on the reduction of perceived barriers. Beliefs about helmet use can vary in accordance with the cyclist's profile, as well as cultural and contextual factors. Assessment of beliefs in specific settings and populations will provide a better basis for planning interventions. The limitations of the present study are mainly related to the instrument used (online survey) and to the differences in sample sizes across countries. (C) 2019 Elsevier Ltd. All rights reserved.

Introduction: This study aimed to assess the physical, psychological, and economic burden shouldered by severely injured two-wheel users in three European countries as well as the cost resulting from their hospitalization. Methods: A total of seven public hospitals were involved in three countries: Greece, Italy, and Germany. Participants enrolled during a 12-month period starting in April 2013. Eligibility criteria included an injury sustained at Road Traffic Crashes (RTC) irrespective of the type of vehicle, hospitalization 1 day in the Intensive Care Unit (ICU) or sub-ICU, and age 18 years or over. Patients were interviewed at 1, 6, and 12 months upon admission. The study used widely recommended classifications for injury severity (Abbreviated Injury Severity [AIS]; Maximum Abbreviated Injury Severity [MAIS]) and standardized measures such as the Disability Assessment Schedule II (WHODAS 2.0), "Impact of Event Scale" (IES-R), Center for Epidemiological Studies Depression Scale (CES-D Scale). Health Care Expenditure was assessed through the Monash University Accident Research Centre (MUARC's) framework, which included measures of 'Direct' and 'Indirect' costs. Diagnosis-related groups (DRGs) were used to estimate hospitalization costs. Results: A total of 54 two-wheel users enrolled in the study in all the countries and 32 completed all follow-up questionnaires. Physical disability increased over 12 months following the injury. Post Traumatic Stress Disorder (PTSD) symptoms of avoidance remained at high levels over the study period. PTSD symptoms of intrusion improved significantly during the second half of the year under investigation. The total annual cost of injury for the two-wheel users who were hospitalized in the selected ICU of all the partner countries for severe injury in 2013/2014, was estimated at 714,491 made up of 123,457 direct and 591,034 indirect costs. Men, aged 50-64 years and those who sustained slight injuries primarily at the lower extremities presented higher indirect costs per person. A total of 1032.092 was spent on hospitalization payments. Women, aged 65 + and those who sustained severe injuries at the central body region presented higher direct costs per person. Women, aged 50-64 years, those with severe injuries and a major injury at the central body and the upper body region presented the highest hospitalization costs per person. Conclusions: There is a need for effective strategies to early detect and treat groups at risk of being confronted with prolonged psychosocial and economic consequences. Practical implications: A holistic understanding of the impact of injury on individuals is important in order to achieve effective treatment of psychological co-morbidities in a timely manner. (C) 2018 National Safety Council and Elsevier Ltd. All tights reserved.

Introduction: The increased bicycle use for transport as an alternative to motorized vehicles has by now become a common occurrence in all Italian cities. Even though the benefits of using a helmet to protect against trauma in bicycle accidents have been demonstrated, its use is still limited. The objective of this study is to analyse those motivations for helmet wearing that can influence their adoption. Methods: Data was gathered through an online questionnaire in collaboration with the Federazione Italiana Amici della Bicicletta (Italian Federation of Friends of the Bicycle), a recreational cyclists association. Motivations to use a helmet were investigated using a factorial analysis model. Factors were analysed through a points allocation system and compared according to gender, area of residence and whether the cyclist was a helmet-enthusiast. Results: The sample was made up of 1781 individuals, with a declining participation rate from North to South; 63% of respondents were men. Three factors were identified from the sample: helmet use as a safety benefit; helmets being perceived as a hindrance; and helmet used out of habit as well as to follow the virtuous example of friends and/or acquaintances during cycling outings. The major kinds of evidence are: regarding gender, differences in the perception of a helmet as a hindrance (p < 0.001) and its use out of habit (p < 0.001); as for area of residence, differences in the perception of a helmet as a hindrance (p = 0.01) and its use out of habit (p < 0.01); as regards being a helmet-enthusiast, differences were found for all the factors (p < 0.01). Conclusions: These results contribute to understanding the scenario that affects motivational beliefs through facilitating or deterring cyclists from using a helmet during recreational cycling. The evidence suggests how to argue the helmet use discussion among Italians. In such a homogeneous population of respondents in terms of passion for cycling, opinions on helmet use were dissimilar from the point of view of both its perception and the subsequent motivation for using it. Exploring perceptions and motivations on helmet use is a key element in understanding cyclists' behaviour in order to characterize different users. A combination of friends/peer influence, reduction in the perception of helmets as a hindrance, and reinforcing of safety could represent the starting point for planning interventions. (C) 2018 Elsevier Ltd. All rights reserved.

Police crash reports are often the main source for official data in many countries. However, with the exception of fatal crashes, crashes are often underreported in a biased manner. Consequently, the countermeasures adopted according to them may be inefficient. In the case of bicycle crashes, this bias is most acute and it probably varies across countries, with some of them being more prone to reporting accidents to police than others. Assessing if this bias occurs and the size of it can be of great importance for evaluating the risks associated with bicycling. This study utilized data collected in the COST TU1101 action "Towards safer bicycling through optimization of bicycle helmets and usage". The data came from an online survey that included questions related to bicyclists' attitudes, behaviour, cycling habits, accidents, and patterns of use of helmets. The survey was filled by 8655 bicyclists from 30 different countries. After applying various exclusion factors, 7015 questionnaires filled by adult cyclists from 17 countries, each with at least 100 valid responses, remained in our sample. The results showed that across all countries, an average of only 10% of all crashes were reported to the police, with a wide range among countries: from a minimum of 0.0% (Israel) and 2.6% (Croatia) to a maximum of a 35.0% (Germany). Some factors associated with the reporting levels were type of crash, type of vehicle involved, and injury severity. No relation was found between the likelihood of reporting and the cyclist's gender, age, educational level, marital status, being a parent, use of helmet, and type of bicycle. The significant under-reporting - including injury crashes that do not lead to hospitalization - justifies the use of self-report survey data for assessment of bicycling crash patterns as they relate to (1) crash risk issues such as location, infrastructure, cyclists' characteristics, and use of helmet and (2) strategic approaches to bicycle crash prevention and injury reduction.

Cycling is becoming one of the most popular forms of recreation and transport the world over, but cyclists still have a high level of vulnerability. A bicycle helmet is an important safety device available to cyclists, but little is known regarding possible determinants of helmet use among adults. This study aims at providing information on helmet usage patterns in Italy and identifying the factors associated with bicycle helmet use. Data on 2072 bicycle riders from an Italian friends of cycling association aged 18 years or older who had ridden a bicycle in the last month were collected using an ad-hoc questionnaire via the web. The sample was equally distributed among subjects who always, most of the time, sometimes, rarely, or never use a helmet. To evaluate the association among socio-demographic and bicycle use characteristics and helmet use, a multinomial logistic regression model was performed. The results show a higher propensity to use a helmet among males, riders coming from Central and Southern Italy, people who cycles more than 60 kilometres in a week, cyclists who have already had a crash, people who do not cycle daily or almost daily, riders of sport bikes. Moreover, the propensity to use a helmet increases with age. The survey provided a first step in approaching the lack of data on cycling behaviour and the wearing of a helmet in Italy.

This study analyzed the most common types of accident involving bicycles and compared the frequency of injuries. The data source was the database of German In-Depth Accident Study (GIDAS). Cases consist of bicycles and their riders involved in accidents between 2000 and 2010. In most collisions, the bicycle impacted with a car. The percentage of injured bicyclists was higher in collisions with a heavy vehicle and decreased when the bicycle impacted with lighter vehicles. A high percentage of injured bicyclists in single accidents was observed; the most severe injury was more frequently to head and extremities. Accidents involving a car and a bicycle with the right of way in a bicycle path represented about 20% of involved and injured bicyclists. The ten most frequent configurations represented about 60% of involved and injured bicyclists. These results contribute to understand the dangerous scenarios for bicyclists and to suggest preventive actions.

Introduction The financial cost of injuries sustained in road traffic crashes is high for victims, families and national budgets, but there is limited information on the cost of injury from the victims’ perspective, especially in terms of the hard-to-reach multi-trauma patient population such as those admitted to the intensive care units of hospitals. Materials and methods The current study received funding by the European Commission Directorate-General Mobility and Transport. It is a prospective, prevalence-based, cost-of-illness study. Participants admitted in the intensive care units of seven public hospitals in Greece, Germany and Italy because of injuries from road traffic crashes, during one year, were enrolled in the study. Patients were followed-up for one year after the intensive care unit admission to report emerging direct and indirect costs related to their injury. Results A total of 120 people were enrolled. Males, those aged 25–49, motorcyclists and those severely injured (Maximum Abbreviated Injury Scale (MAIS) 3+) with highest severity located at the central part of the body, accounted for the highest percentages of both the direct and indirect injury costs. The highest average direct costs were for females, those aged 50–64, pedestrians and those slightly injured (MAIS 1 or 2) with highest severity at the central region of the body. Males, patients aged 25–49, car passengers and truck drivers as well as those slightly injured (MAIS 1 or 2) with highest severity at multiple locations were over-represented in the average indirect costs. Conclusions Those groups that account for a high percentage of injury costs should be targeted in health policy initiatives.