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PubMed1993

Penetrating ocular injuries secondary to motor vehicle accidents.

BACKGROUND: Penetrating ocular trauma is second only to cataracts as the most common cause of visual impairment in the United States; motor vehicle accidents are an important cause of injuries (ocular and non-ocular). METHODS: The files of 293 consecutive patients treated for a penetrating ocular injury over a 5-year period (1986 to 1991) were reviewed, and 10 (3.4%) were associated with a motor vehicle accident. RESULTS: Median age was 27.5 years and median initial visual acuity was 20/200 (range, 20/30 to light perception). A sharp glass fragment penetrating the eye was the mechanism of injury in seven cases. A seatbelt was worn by only one patient. Six patients had a corneoscleral laceration, and two patients each had corneal and scleral lacerations. Primary repair of the laceration was solely performed in eight patients. Vitreous surgery was required in two cases, one with retained intraocular foreign bodies and one with a retinal detachment. The median follow-up period was 5 months, and 8 of 9 retinas remained attached at final follow-up. One patient died of unrelated causes. Final median visual acuity was 20/25 (range, 20/20 to hand motions). CONCLUSION: Among patients in a large series of penetrating ocular injuries, the percentage of injuries due to motor vehicle accidents is low. The anterior segment is predominantly involved, and the final visual prognosis is favorable. Compulsory seatbelt legislation may reduce the frequency and morbidity of these accidents in the United States.

Accidents, Traffic↗
PubMed2006

Injuries from motor-vehicle collisions with moose--Maine, 2000-2004.

Moose are among the largest mammals in North America. Standing up to 7.5 feet at the shoulder and weighing up to 1,600 lbs, they are the largest members of the deer family. Maine's moose population (approximately 29,000) is the biggest in the United States outside of Alaska. During a collision with a motor vehicle, a moose usually is struck in the legs, causing its body to roll onto the hood of the vehicle, often collapsing the windshield and roof. As a result, motor-vehicle collisions involving moose are capable of causing substantial injury to vehicle occupants. To assess motor-vehicle collisions with moose in Maine and evaluate risk factors for injuries from these types of collisions, the Maine Department of Health and Human Services studied collision reports from 2000--2004. The results of that study indicated that collision rates varied by county but had clear patterns by season and time of day. Variables associated with risk for injury were posted speed limit, type of vehicle, and sex and age of the driver. Measures to reduce collisions with moose should focus on improving driver education programs and developing better engineering controls (e.g., removing roadside vegetation to improve visibility for drivers). In addition, herd management (i.e., decreasing moose population size through hunting) is currently being used in areas of Maine with high numbers of collisions, although studies are needed to assess its effectiveness.

Accidents, Traffic↗
PubMed1990

The changing pattern of suicide by gassing in Australia, 1910-1987: the role of natural gas and motor vehicles.

There have been large changes in the use of gas as a suicide method in Australia during this century, the most marked being the increased use of motor vehicle exhaust fumes, and the introduction of natural gas in the early 1960s. In males, use of motor vehicle exhaust fumes as a suicide method has substituted for use of domestic gas. It was concluded that in neither sex did the elimination of toxic carbon monoxide in domestic gas, with the introduction of natural gas, result in a lasting reduction of suicide rates. Attention is drawn to possible failed suicide attempts using motor vehicles with emission controls, resulting in serious cerebral damage.

Australia↗
PubMed1999

Role of commercial drivers in motor vehicle related injuries in Ghana.

INTRODUCTION: In many low income countries, commercial vehicles are the major source of motorized transport. Drivers of such vehicles may be an important focus for road safety efforts. AIMS: An estimation of the percentage of motor vehicle related injuries that involved commercial vehicles in Ghana was sought. The knowledge, attitude, and practices of commercial drivers with regards to road safety was then evaluated. METHODS: A community based survey was carried out, involving 21105 persons. As well, focus group discussions were held with 30 commercial drivers. RESULTS: In the survey, 122 motor vehicle related injuries were reported for the preceding year. The majority (81%) of these involved commercial vehicles, principally buses (40%) and taxis (24%). The involvement of commercial vehicles was the same for both motor vehicle crashes (81%) and pedestrian injuries (82%). However, motor vehicle related injuries in children were especially likely to involve commercial vehicles (95%), in comparison with adults (79%). The focus groups indicated that commercial drivers had a good general attitude towards road safety. Most believed that actions could be taken that would lower the risk of crashes and injuries, including vision examinations, using seat belts, and avoiding alcohol. However, this knowledge was not fully implemented. For example, few drivers had ever had their vision checked and most used seat belts only for long journeys. CONCLUSIONS: In Ghana, commercial drivers are an important group to target in road safety programs. They are also a potentially useful group to include in building coalitions to implement such road safety measures.

Accidents, Traffic↗
PubMed2006

Use and misuse of motor-vehicle crash death rates in assessing highway-safety performance.

OBJECTIVES: The objectives of the article are to assess the extent to which comparisons of motor-vehicle crash death rates can be used to determine the effectiveness of highway-safety policies over time in a country or to compare policy effectiveness across countries. METHODS: Motor-vehicle crash death rates per mile traveled in the 50 U.S. states from 1980 to 2003 are used to show the influence on these rates of factors independent of highway-safety interventions. Multiple regression models relating state death rates to various measures related to urbanization and demographics are used. RESULTS: The analyses demonstrate strong relationships between state death rates and urbanization and demographics. Almost 60% of the variability among the state death rates can be explained by the independent variables in the multiple regression models. When the death rates for passenger vehicle occupants (i.e., excluding motorcycle, pedestrian, and other deaths) are used in the regression models, almost 70% of the variability in the rates can be explained by urbanization and demographics. CONCLUSIONS: The analyses presented in the article demonstrate that motor-vehicle crash death rates are strongly influenced by factors unrelated to highway-safety countermeasures. Overall death rates should not be used as a basis for judging the effectiveness (or ineffectiveness) of specific highway-safety countermeasures or to assess overall highway-safety policies, especially across jurisdictions. There can be no substitute for the use of carefully designed scientific evaluations of highway-safety interventions that use outcome measures directly related to the intervention; e.g., motorcyclist deaths should be used to assess the effectiveness of motorcycle helmet laws. While this may seem obvious, there are numerous examples in the literature of death rates from all crashes being used to assess the effectiveness of interventions aimed at specific subsets of crashes.

Accidents, Traffic↗
PubMed1992

Temporomandibular disorders, facial pain and headache following motor vehicle accidents.

Temporomandibular disorders are known to be a possible sequela of motor vehicle accidents, particularly when flexion-extension injury occurs. This paper recognizes the relationship between cervical injury and dysfunction, and temporomandibular dysfunction and headache. The literature related to motor vehicle accidents, whiplash injury, and temporomandibular dysfunction is reviewed, and the etiology, prognosis and management of the trauma associated with head and neck pain and dysfunction are presented.

Accidents, Traffic↗
PubMed2003

Development of a microscale emission factor model for particulate matter for predicting real-time motor vehicle emissions.

The U.S. Environmental Protection Agency's National Exposure Research Laboratory is pursuing a project to improve the methodology for modeling human exposure to motor vehicle emissions. The overall project goal is to develop improved methods for modeling the source through the air pathway to human exposure in significant exposure microenvironments. Current particulate matter (PM) emission models, particle emission factor model (used in the United States, except California) and motor vehicle emission factor model (used in California only), are suitable only for county-scale modeling and emission inventories. There is a need to develop a site-specific real-time emission factor model for PM emissions to support human exposure studies near roadways. A microscale emission factor model for predicting site-specific real-time motor vehicle PM (MicroFacPM) emissions for total suspended PM, PM less than 10 microm aerodynamic diameter, and PM less than 2.5 microm aerodynamic diameter has been developed. The algorithm used to calculate emission factors in MicroFacPM is disaggregated, and emission factors are calculated from a real-time fleet, rather than from a fleet-wide average estimated by a vehicle-miles-traveled weighting of the emission factors for different vehicle classes. MicroFacPM requires input information necessary to characterize the site-specific real-time fleet being modeled. Other variables required include average vehicle speed, time and day of the year, ambient temperature, and relative humidity.

Air Pollutants↗
PubMed1994

Psychological morbidity associated with motor vehicle accidents.

Fifty victims of recent motor vehicle accidents (MVAs), who had sought medical attention after their accidents, were assessed for possible psychological morbidity as a result of the accident. Forty age, gender-matched controls were also assessed with the same instruments. Forty-six percent of the MVA victims met the criteria for current post-traumatic stress disorders (PTSD) as a result of the accident while 20% showed a sub-syndromal version (the reexperiencing symptom cluster plus either the avoidance/numbing cluster or the over-arousal cluster) of PTSD. Although all MVA victims showed some form of driving reluctance, only 1 S met the criteria for driving phobia. Those MVA victims who met the criteria for PTSD or sub-syndromal PTSD were significantly more likely to have experienced previous trauma, other than a serious MVA, and were more likely (P = 0.008) to have previously met the criteria for PTSD as a result of that trauma. Forty-eight percent of MVA victims who met the criteria for current PTSD also met the criteria for current major depression. Significantly more current MVA-PTSDs had suffered previous major depressive episodes.

Accidents, Traffic↗
PubMed2005

Attributions of responsibility for motor vehicle crashes.

A sample of 321 motor vehicle crash survivors completed a survey in which they provided attribution ratings of the extent to which they were responsible for their crashes, other people (drivers) were responsible, or road/weather conditions were responsible. The attribution ratings were consistent with the predictions of defensive attribution theory (DAT; [Walster, E., 1966. Assignment of responsibility for an accident. J. Pers. Soc. Psychol. 3, 73-79]) in that people who experienced crashes of greater severity (necessitating medical treatment for injuries) attributed greater responsibility to other drivers than to self or to weather/road conditions. People who were in crashes of lesser severity attributed approximately the same amount of responsibility to themselves as they did to others. An actor-observer effect also appeared in survivors' attribution ratings in that self-acceptance of responsibility for the crash was positively correlated with attributions to the situation (road/weather conditions) whereas such attributions to the situation were negatively correlated with attributions of responsibility to other drivers. Consistent with results of prior research, survivors who assigned crash responsibility to other drivers reported increased levels of driving and riding avoidance compared to people who accepted responsibility for their crashes.

Accidents, Traffic↗
PubMed2003

A controlled evaluation of cognitive behavioural therapy for posttraumatic stress in motor vehicle accident survivors.

Seventy-eight motor vehicle accident survivors with chronic (greater than 6 months) PTSD, or severe sub-syndromal PTSD, completed a randomized controlled comparison of cognitive behavioral therapy (CBT), supportive psychotherapy (SUPPORT), or a Wait List control condition with two detailed assessments. Scores on the CAPS showed significantly greater improvement for those in CBT in comparison to the Wait List and to the SUPPORT conditions. The SUPPORT condition in turn was superior (p=0.012) to the Wait List. Categorical diagnostic data showed the same results. An analysis of CAPS scores including drop-outs (n=98) also showed CBT to be superior to Wait List and to SUPPORT with a trend for SUPPORT to be superior to Wait List. The CBT condition led to significantly greater reductions in co-morbid major depression and GAD than the other two conditions. Results held up well at a 3-month follow-up on the two active treatment conditions.

Accidents, Traffic↗
PubMed1983

Bilateral eye injuries from motor vehicle trauma.

Three patients admitted after motor vehicle accident trauma are presented. Each had bilateral eye injuries with significant but variable visual loss. Common features to each were alcohol intoxication and lack of use of seatbelts, and each was young and male. New microsurgical ophthalmological techniques as well as a multidisciplinary surgical approach to these types of injuries are emphasized.

Accidents, Traffic↗
PubMed1996

Efficacy of arthroscopic surgery and midlaser treatments for chronic temporomandibular joint articular disc derangement following motor vehicle accident.

As a result of motor vehicle accident soft-tissue injury, temporomandibular joint articular disc derangement may develop and persist despite symptomatic treatment and medication. This study reports the effectiveness of management directed at controlling the TMJ and masticatory neuromuscular pain dysfunction with a TMJ/interocclusal stabilization appliance, specific biofeedback and ultrasound therapy. Following these conservative measures residual articular disc derangement was present in some subjects who were offered arthroscopic surgery and infrared midlaser with TMJ/occlusal stabilization. Twenty subjects with residual disc derangement were randomly selected into two groups with and without arthroscopic surgery, and analyses of variance made before treatment, 12 months after conservative procedures, 3 months following arthroscopic surgery and midlaser therapy and 3 years since commencement of management. Dependent variables compared were pain-discomfort, Clinical Dysfunction Index, articular disc derangement and maximal voluntary jaw opening. Conservative management alone provided significant reduction of pain-discomfort and clinical dysfunction, while arthroscopic surgery resulted in significant reduction in articular disc derangement. The midlaser with TMJ/occlusal stabilization maintained significant improvement in the variables (p < 0.01) for both groups. The common articular deviations in form found at arthroscopy were soft tissue alteration with hyperaemia, synovitis, synovial membrane and posterior attachment folding with connective tissue hyperplasia, and disc displacement with fibrous adhesions. The Global Status Score of pain behaviour compared with residual function, confirmed the presence of greater pain before treatment commenced.

Accidents, Traffic↗
PubMed2005

Psychiatric risk factors for motor vehicle fatalities in young men.

BACKGROUND: Motor vehicle accident (MVA) fatalities are an important cause of death in young men. Psychiatric disorders have been shown to be risk factors for MVA, but only a few studies have investigated MVA fatalities. METHOD: A case-control study was carried out comparing 61 young male MVA fatalities in which the subject was the driver with an equal number of living male subjects matched for age (case by case with no more than 1 year's difference between case subjects and control subjects) with the accident group. We assessed both groups, using structured interviews and psychological autopsies. RESULTS: Our results suggest that cluster B personality disorders (borderline and [or] antisocial) (OR 3.54; 95%CI, 1.38 to 16.01) and substance use disorders in the last 6 months (OR 4.33; 95%CI, 1.42 to 9.25) increased the risk of dying in MVAs. In addition, we observed an age effect, where differences in cluster B personality disorders and substance use disorders in the last 6 months were only significantly more prevalent in case subjects aged 26 years or over, compared with control subjects of the same age. Drivers under age 25 years appeared to be comparable with control subjects on all measures of psychopathology. Finally, this interaction between cluster B personality disorders and age over 26 years was the only significant predictor of car fatalities (adjusted OR 16.25; 95%CI, 1.67 to 158.10). CONCLUSION: Borderline and antisocial personality disorders in which impulsive-aggressive behaviours play a central role and substance use disorders appear to be risk factors for young male deaths in MVAs. Interestingly, this effect seems to be specific to MVA case subjects aged 26 years or over.

Accidents, Traffic↗
PubMed1996

Posttraumatic stress disorder and motor vehicle accidents: a multidisciplinary overview.

OBJECTIVE: Motor vehicle accidents (MVA) may result in intractable disability. This paper investigates posttraumatic stress disorder (PTSD) as a potential cause. METHOD: The literature was reviewed for recent studies on prevalence, symptom profile, and outcome of PTSD. RESULTS: PTSD is prevalent in roughly 10% of survivors of MVAs during the first year. Comorbid depression and pain are common. Medical complications, psychophysiological reactivity, and possibly litigation may slow remission. Phobic symptoms can persist for years. Mood disturbance may augment the impact of pain on daily living and on self-perceived disability. CONCLUSION: Recently developed screening instrument, structured interviews, and behavioural approach tests yield quantitative and reliable assessments of symptom severity. Cognitive-behavioural intervention and antidepressants may improve coping, ease fear, and reduce the impact of pain.

Accidents, Traffic↗
PubMed2006

Motor vehicle trauma: analysis of injury profiles by road-user category.

BACKGROUND: Vehicle accidents in Greece are among the leading causes of death and the primary one in young people. The mechanism of injury influences the patterns of injury in victims of vehicle accidents. OBJECTIVE: Identification and analysis of injury profiles of motor-vehicle trauma patients in a Greek level I trauma centre, by road-user category. PATIENTS AND METHODS: The trauma registry data of Herakleion University Hospital of adult trauma patients admitted to the hospital after a vehicle accident between 1997 and 2000 were retrospectively examined. Patients were grouped based on the mechanism of injury into three road-user categories: car occupants, motorcyclists, and pedestrians. RESULTS: Of 730 consecutive patients, 444 were motorcyclists (60.8%), 209 were car occupants (28.7%), and 77 were pedestrians (10.5%). Young men constituted the majority of injured motorcyclists whereas older patients (p = 0.0001) and women (p = 0.0001) represented a substantial proportion of the injured pedestrians. With regard to the spectrum of injuries in the groups, craniocerebral injuries were significantly more frequent in motorcyclists and pedestrians (p = 0.0001); abdominal (p = 0.009) and spinal cord trauma (p = 0.007) in car occupants; and pelvic injuries (p = 0.0001) in pedestrians. Although the car occupants had the highest Injury Severity Score (ISS) (p = 0.04), the pedestrians had the poorest outcome with substantially higher mortality (p = 0.007) than the other two groups. CONCLUSIONS: The results reveal a clear association between different road-user categories and age and sex incidence patterns, as well as outcomes and injury profiles. Recognition of these features would be useful in designing effective prevention strategies and in comprehensive prehospital and inhospital treatment of motor-vehicle trauma patients.

Accidents, Traffic↗
PubMed2003

Race, Hispanic origin, and socioeconomic status in relation to motor vehicle occupant death rates and risk factors among adults.

Black and Hispanic adults travel less in motor vehicles than whites but may be at greater risk when they do travel. Passenger vehicle occupant deaths per 10 million trips among persons ages 25-64 were computed by race, Hispanic origin, gender, and socioeconomic status (SES) using 1995 data from the Fatality Analysis Reporting System (FARS) and Nationwide Personal Transportation Survey. Educational level was used as the indicator of SES. Blacks, particularly black men, were at increased risk of dying relative to whites when traveling in motor vehicles (rate ratio (RR) for black men=1.48; 95% confidence interval (CI)=1.42-1.54). Hispanic men, but not Hispanic women, also had elevated occupant death rates, but their risk was less than that of black men (RR=1.26; 95% CI=1.20-1.31). SES was the strongest determinant of occupant deaths per unit of travel; RRs among those who had not completed high school were 3.52 (95% CI=3.39-3.65) for men and 2.79 (95% CI=2.69-2.91) for women, respectively. Whites without high school degrees had the highest death rates per 10 million trips. After adjustment for SES, the elevated risk of occupant fatalities persisted among black men and women, but not among Hispanic men. Seat belt use and alcohol-impaired driving were examined among fatally injured passenger vehicle drivers. Among those with no education beyond high school, higher percentages were reported as having high blood alcohol concentrations (BACs) or having not used belts. Reported belt use rates were lower among black men and women, even after controlling for SES, whereas Hispanic men and women had belt use rates similar to those of whites. High BACs were more common among Hispanic men, which appeared largely to be an effect of SES because most Hispanic men killed in crashes had not completed high school, the education level with the highest percentage that drove while impaired by alcohol. More effective public health efforts are needed to reduce occupant deaths among persons of lower SES, blacks, and Hispanics, including measures to increase use of seat belts and reduce alcohol-impaired driving.

Accidents, Traffic↗
PubMed1999

Effectiveness of health promotion programs to increase motor vehicle occupant restraint use among young children.

OBJECTIVE: To review the effectiveness of nonlegislative community and clinical programs to increase the rate of child motor vehicle occupant restraint use among children under the age of 5 years. METHOD: This was a systematic review of the world's published literature. The Cochrane Collaboration protocol was used to conduct the literature search. The following databases were searched for literature on this topic: MEDLINE, EMBASE, NTIS, PsychINFO, ERIC, Nursing and Allied Health, Transportation Research and Information Service, and EI Compendex. The bibliographies of relevant publications were used to search for additional references. SELECTION CRITERIA: Studies were included if they evaluated a clinical or community-based intervention designed to increase the use child restraint devices among motor vehicle passengers under the age of 5 years. Studies of the effects of legislation or law enforcement programs were excluded. All study design types, including randomized controlled trials, controlled trials, and controlled or uncontrolled pre/post evaluations, were included. Studies were excluded if there was either no control group or no baseline data with which to compare outcome data. Studies were also excluded if they did not use observed restraint use as at least one of the outcome measures. DATA COLLECTION: Each study was reviewed in depth with special attention to the strength of study design. Outcomes were assessed in terms of the absolute difference in observed restraint use within and/or between groups across study intervals. RESULTS: A total of 18 studies met inclusion criteria for in-depth review. Pooling of results was not possible because of the large differences between studies with regard to study design, settings, target groups, intervention methods, and units of analysis. There were a total of three randomized controlled trials, four controlled trials without random individual or group assignment, three controlled pre-post evaluations, and eight uncontrolled pre/post studies. Among preschool programs, short-term absolute percentage point gains in seat belt use rates ranged from 12% to 52% but only from 8% to 14% one month or more after the intervention. Among community-based media campaigns, long-term child restraint use increased by an absolute margin of 5% to 14%. Of the eleven peri-partum counseling programs, long-term follow-up revealed gains of 6% to 27% with most between 10% to 15%. Many studies had serious design flaws that could overestimate the magnitude of the effect. CONCLUSIONS: Programs to increase the rate of child restraint use among child occupants of motor vehicles appear to have overall moderate short-term effectiveness. The magnitude of the positive program effects one or more months after the intervention appear to diminish substantially. There is a strong need for high quality randomized controlled trials to determine the long-term effectiveness of child restraint promotion programs.

Automobile Driving↗
PubMed2004

[Aging and psychological assessment of motor vehicle driving capability].

BACKGROUND: The aim of the present project was to determine: (a) at what age the psychomotor functions begin to decline, which would justify routine testing to assess them, and (b) at what level the declining psychomotor functions can be recognized as a contraindication against driving motor vehicles. MATERIALS AND METHODS: The subjects were 186 motor vehicle drivers, aged 26-64 years. The parameters examined included eye-hand coordination and reaction time. RESULTS: The analysis of the results revealed that a significantly decreased level of psychomotor function could be noted at the age of 45 years. CONCLUSIONS: It was assumed that the results of psychological tests performed by persons with 0.05% BAC can be the empirical criterion for a decline that would significantly impair the driver's work capability. The findings of our study made it possible to develop a proposal for modifying the testing procedure and the principles of certifying work capability of motor vehicle drivers.

Age Factors↗