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PubMed2005

State motor vehicle laws and older drivers.

After teenage males, elderly individuals have the highest per capita motor vehicle fatality rate in the United States. Surprisingly, there has been only limited work examining the effect of state motor vehicle laws on older driver fatalities. This paper uses state-level data from the 1985-2000 Fatality Analysis Reporting System to examine the effects of changes in state laws dealing with license renewal, seatbelt use, speed limits, and driving while intoxicated on fatalities among drivers and others aged 65 and over. Negative binomial regressions are estimated using alternatively state and year fixed effects, or age and year fixed effects. In-person license renewal reduced fatalities among the oldest drivers, but vision tests, road tests and the length of the license renewal cycle generally did not. In terms of policies that apply to all drivers, seatbelt laws, particularly with primary enforcement, were generally the only policies that reduced older driver fatalities. These results are noteworthy because a number of policies that have been effective towards increasing younger driver safety are not relevant for older drivers, implying that policymakers must think broadly about using state laws to improve older driver safety.

Accidents, Traffic↗
PubMed2000

[Analysis of hospital morbidity by motor vehicle accidents in public hospitals in Rio de Janeiro, Brazil].

INTRODUCTION: Morbidity due to motor vehicle accidents was analysed in a descriptive study based on reports of hospitals with the objective to characterize their victims, types of injuries, and the health care provided. METHODS: The study was carried out in two municipal hospitals of Rio de Janeiro, Brazil. Motor vehicle accidents were defined as a run over, a collision, and "other traffic accidents". Data was collected from cases seen in May (Hospital 1) and June (Hospital 2) of 1996 by 7 teams that alternated in shifts of 12 hours, covering the collection 24 hours per day. The events were classified according to the victim or, when it was impossible, to the person who helped them or accompanied them to the hospital. RESULTS: In the study period, 320 cases were seen in Hospital 1 and 290 in Hospital 2. Most of the victims were men (69.3%) in both of hospitals and the most affected group was young adults between 20 to 39 years (60.5% in Hospital 1 and 47.5% in Hospital 2). Of all 610 cases, the main cause of injury was being run over (49.3%), followed by collisions (35.6%), and "other traffic accidents" (15.1%). CONCLUSIONS: The analysis of the cases distributions and the type of care required corroborates with the need of a better organization of hospital care teams, more completeness of hospital reports and emphasis on some aspects in prevention campaigns.

Accidents, Traffic↗
PubMed1996

Motor vehicle crashes in roadway construction workzones: an analysis using narrative text from insurance claims.

Motor vehicle travel through roadway construction workzones has been shown to increase the risk of a crash. The number of workzones has increased due to recent congressional funding in 1991 for expanded roadway maintenance and repair. In this paper, we describe the characteristics and costs of motor vehicle crashes in roadway construction workzones. As opposed to using standard accident codes to identify accident types, automobile insurance claims files from 1990-93 were searched to identify records with the keyword "construction" in the accident narrative field. A total of 3,686 claims were used for the analysis of crashes. Keywords from the accident narrative field were used to identify five pre-crash vehicle activities and five crash types. We evaluated misclassification error by reading 560 randomly selected claims and found it to be only 5%. For each of four years, 1990-93, there was a total of 648,996,977 and 1,065 crashes, respectively. There was a 70% increase in the crash rate per 10,000 personal insured vehicles from 1990-93 (2.1-3.6). Most crashes (26%) involved a stopped or slowing vehicle in the workzone. The most common crash (31%) was a rear-end collision. The most costly pre-crash activity was a major judgment error on the part of a driver (n = 120, median cost = $2,628). An overturned vehicle was the most costly crash type (n = 16, median cost = $4,745). In summary, keyword text analysis of accident narrative data used in this study demonstrated its utility and potential for enhancing injury epidemiology. The results suggest interventions are needed to respond to growing traffic hazards in construction workzones.

Accidents, Traffic↗
PubMedDate not supplied

Ocular injuries secondary to motor vehicle accidents.

PURPOSE: Ocular trauma is one of the main causes of visual reduction or loss, particularly in the younger population. METHODS: In this prospective study the authors included 67 consecutive patients with ocular trauma secondary to motor vehicle accidents who were hospitalized in the Athens University Eye Clinic from September 1993 to December 1996. The mean follow-up time was 31 months, the mean age was 31.7 years, and the ratio between men and women was 2.7:1. RESULTS: Thirty-two of the accidents (47.76%) took place in populated areas. Among the 67 injured persons, 58 (86.56%) were car passengers, 8 (11.95%) were on motorcycles, and 1 (1.49%) was a pedestrian. Only 3 (5.2%) of the 58 persons injured inside automobiles used safety belts and none of the motorcyclists used crash helmets during the accidents. Fifty-three (79.1%) ocular traumas were penetrating in nature, with glass fragments being the main cause in 36 of them (67.9%). Among the 53 injured persons experiencing penetrating ocular trauma, 49 had a follow-up time of more than 6 months. Twenty of them (40.8%) underwent one surgical procedure, 22 (44.9%) were submitted to two surgical procedures, and the remaining 7 persons (14.3%) needed three or more operations. Eighteen (36.7%) of the 49 patients with penetrating ocular trauma and with 6 months follow-up had a final visual acuity of less than 1/20, 21 (42.9%) had a visual acuity of more than 5/10, and 3 (6.1%) underwent enucleation. Among the 67 patients, 61 had a follow-up time of more than 6 months, regardless of their history of penetrating ocular trauma. Eighteen of them (29.5%) had a final visual acuity of less than 1/20, 8 (13.1%) had a visual acuity between 2/10 and 4/10, and 22 (52.5%) had a visual acuity of more than 5/10. CONCLUSIONS: Because motor vehicle accidents can cause severe ocular trauma, it would be helpful for drivers to be more careful and aware of motor vehicle regulations. There seems to be a great need of enforcement of seatbelt laws in Greece.

Accidents, Traffic↗
PubMed2006

Motor vehicle exhaust gas suicide in Victoria, Australia 1998-2002.

Motor vehicle exhaust gas suicide (MVEGS) is the second most frequent method of suicide in Victoria, Australia. It is a highly lethal method of suicide with 1.5 deaths for every hospital admission. Australian regulations require all vehicles manufactured since 1998 to have a maximum carbon monoxide exhaust emission level of 2.1 g/km, reduced from the previous level of 9.6 g/km. Information surrounding all Victorian MVEGS between 1998-2002 was analyzed to determine whether suicides occurred in vehicles with the lower emission levels. Between 1998-2002, 607 suicides by this means were recorded while just 393 hospital admissions were recorded for the same period. Mean carboxyhaemoglobin levels were significantly lower in fatalities using vehicles manufactured from 1998, however suicide still occurred in these vehicles (n = 25). The extent to which the new regulations contributed to the relatively low rate of suicide in vehicles less than 5 years old compared to their frequency in the fleet remains unknown. Based on international experience and the age of the Victorian vehicle fleet, it may take well over a decade until substantial decreases in MVEGS are observed in the absence of active preventive measures.

Australia↗
PubMed2000

The motor vehicle collision injury syndrome.

OBJECTIVE: The objective of this study was to examine the central nervous system changes that may occur after acceleration/deceleration injuries in motor vehicle accidents. BACKGROUND: Occupants of motor vehicles involved in a collision often develop a disabling syndrome consisting of head, neck, and back pain; impaired short-term memory and concentration; fatigue and a loss of stamina; poor balance; and a change in personality. Injury victims experience a loss of motivation, emotional lability, and a decrease in libido. The major features of this injury syndrome are subjective, and there usually are few objective findings on physical examination. The pathogenesis of this syndrome is poorly understood, but it is hypothesized that the collision impact produces an inertial strain injury to the anterior regions of the brain which depresses the functions of the frontotemporal lobes, at the same time, sensitizing somatosensory neural afferent systems. Damage to the orbital surfaces of the frontotemporal lobes, in particular, impairs the gating mechanisms that normally limit sensory input to the brain and further promotes central sensitization. The psychiatric disorders that emerge in the wake of these injuries are likely grounded in these pathologic events. METHOD: The current literature on the biomechanics of head injury and the associated brain imaging findings in minor head injury are reviewed. A summary of some of the biochemical sequelae of strain injury to the brain is also provided, with an emphasis on the changes in energy metabolism and excitatory amino acid release. CONCLUSIONS: Early intervention to arrest the injury-induced metabolic cascade, and treatment with agents that activate cerebral metabolism may mitigate the symptoms of this injury syndrome.

Accidents, Traffic↗
PubMed1989

Unintentional deaths from carbon monoxide in motor vehicle exhaust: West Virginia.

We investigated the circumstances of unintended carbon monoxide deaths from motor vehicle exhaust. Of 64 episodes involving 82 deaths investigated by the West Virginia Office of the Chief Medical Examiner, 1978-84, 50 occurred outdoors in older vehicles with defective exhaust systems and 14 occurred in enclosed or semi-enclosed home garages. Blood alcohol was detected in 50 (68 per cent) of 74 victims tested; 34 had blood alcohol concentrations greater than or equal to 0.10 g/dl. We suggest increasing public awareness of the hazards of motor vehicle exhaust and enforcing vehicle inspection regulations.

Adolescent↗
PubMed2005

Motor vehicle accidents during episodes of hypoglycaemia--case reports and lessons to be learnt.

BACKGROUND: Hypoglycaemia is a common adverse effect of insulin treatment in individuals with diabetes, potentially leading to cognitive impairment, altered levels of consciousness and delayed reactions. If this happens while driving a motor vehicle, a disastrous accident may ensue. OBJECTIVE: This article describes the clinical scenarios of five men with type 1 diabetes who were involved in motor vehicle accidents due to severe hypoglycaemia and discusses the potential risk factors for hypoglycaemia. DISCUSSION: Reference is made to the specific management guidelines set out by the Australian Driver Licensing Authorities for individuals with diabetes. Sometimes, important ethical decisions can be difficult when managing diabetic individuals who fail to comply with therapy or who suffer hypoglycaemia related events and continue to drive a motor vehicle.

Accidents, Traffic↗
PubMed2003

Mortality among hourly motor vehicle manufacturing workers.

We evaluated mortality among 198,245 motor vehicle industry workers during the period of 1973 to 1995. Workers' mortality rates were lower than expected overall (40,131 observed/43,859 expected deaths, standardized mortality ratio [SMR] = 92, CI = 91-92) and for all major cause of death categories except cancer (SMR = 100, CI = 98-102). Mortality rates were higher than expected for lung cancer overall (SMR = 110, CI = 107-113) and among employees in transmission/gear manufacturing (SMR = 121, CI = 112-130), casting operations (SMR = 122, CI = 110-135), engine manufacturing (SMR = 111, CI = 101-123), and vehicle assembly (SMR = 111, CI = 105-117); for stomach cancer in engine manufacturing (SMR = 147, CI = 110-192); and for prostate cancer in casting operations (SMR = 128, CI = 102-158). Excesses of lung cancer in transmission, vehicle assembly, and casting operations and of stomach cancer in engine manufacturing have been observed in other investigations. Further information on employees' occupational exposures and personal attributes is required to clarify the interpretation of these results.

Accidents, Occupational↗
PubMed2000

Impact of a helmet law on two wheel motor vehicle crash mortality in a southern European urban area.

BACKGROUND: In Spain, a federal road safety law went into effect in the fall of 1992 extending to urban areas the unrestricted use of safety helmets by all two wheel motor vehicle occupants. OBJECTIVES: To assess the effect of the law in reducing fatal motorcycle crash injuries; to estimate the number of lives saved; and to determine changes in the distribution of severity and anatomical location of injuries. METHODS: Pre-test/post-test design of all deaths of two wheel motor vehicle occupants from 1990-92 (pre-law period) and from 1993-95 (post-law period) detected by the Barcelona Forensic Institute and the city police department. Injuries were coded using the 1990 version of the abbreviated injury scale. Poisson regression methods were used to model trends in mortality ratios and to provide estimates of the number of lives saved. RESULTS: Between 1993 and 1995, 35 lives of two wheel motor vehicle occupants were spared, representing a decrease of 25% in the observed motorcycle crash mortality in the post-law period when compared with what would be expected if no such law had gone into effect. The proportion of deaths with severe head injuries was also reduced from 76% to 67% in the post-law period. CONCLUSIONS: This study offers the first evaluation of a helmet law using combined forensic and police data in a large south European urban area where there is widespread use of motorcycles. Our results confirm the effectiveness of the helmet law, as measured by the reduction in the number of deaths and mortality ratios after the law implementation. The findings reinforce the public health benefits of mandatory non-restricted motorcycle and moped helmet use, even in urban areas with lower traffic speeds.

Accidents, Traffic↗
PubMed1990

A short course on motor vehicle injury for emergency medicine residents.

Despite growing interest and activity by emergency physicians in injury prevention, we found no reports of any attempts to include injury control concepts in emergency medicine residency training. An existing course for graduate level public health students on motor vehicle injury was modified for emergency medicine residents, presented as a one-day short course, and evaluated. The objective of the course was to provide information regarding the dynamics and prevention of motor vehicle crashes. An equally important second objective was to demonstrate to the residents the need for emergency physicians as part of the injury control research team. The content of the course was based on the conceptual model in which a motor vehicle crash is analyzed in terms of precrash, crash, and post-crash factors. The correlation between the mechanism of injury and the types of injuries experienced was of particular interest. A one-day format was found to be too concentrated. The incorporation of injury prevention concepts and research methods into the grand rounds, journal club, and conferences of the emergency medicine residency is recommended. Educational objectives and practical suggestions for implementation are provided. A comprehensive reading list is available on request.

Accidents, Traffic↗
PubMedDate not supplied

Use of behavioral risk factor surveys to predict alcohol-related motor vehicle events.

The relationship between acute alcohol intoxication and increased risk of traffic violations, crashes, and injuries is well known. We designed this study to investigate the usefulness of behavioral risk factor surveys (BRFSs) in identifying drivers at risk for subsequent motor vehicle violations and crashes. We carried out a retrospective cohort study in a random sample of members of a health maintenance organization, who were followed for five years after ascertainment of alcohol use. Reported problem drinking behavior increased the risk of motor vehicle violations or crashes for women drivers and older drivers (older than 65 years of age) of both sexes. Women "binge drinkers" had an age-adjusted relative risk (RR) for violations of 1.7 (95% confidence interval [CI] = 1.1, 2.8) and an age-adjusted RR for crashes of 1.9 (95% CI = 1.1, 3.2). Older drivers reporting drinking and driving or multiple drinking problems had an increased risk of motor vehicle crashes (sex-adjusted RR = 2.7; 95% CI = 1.2, 5.8, and 3.0; 95% CI = 1.1, 8.4). A CAGE score of 2 or more identified older drivers at increased risk for both violations and crashes. We found no increased risk for male drivers under 65 years of age for any of the problem drinking behaviors. We conclude that BRFSs in a general population can help identify high-risk drivers among women and drivers older than 65 years of age.

Accidents, Traffic↗
PubMed2004

Improving surveillance for injuries associated with potential motor vehicle safety defects.

OBJECTIVE: To improve surveillance for deaths and injuries associated with potential motor vehicle safety defects. DESIGN: Vehicles in fatal crashes can be studied for indications of potential defects using an "early warning" surveillance statistic previously suggested for screening reports of adverse drug reactions. This statistic is illustrated with time series data for fatal, tire related and fire related crashes. Geographic analyses are used to augment the tire related statistics. RESULTS: A statistical criterion based on the Poisson distribution that tests the likelihood of an expected number of events, given the number of events that actually occurred, is a promising method that can be readily adapted for use in injury surveillance. CONCLUSIONS: Use of the demonstrated techniques could have helped to avert a well known injury surveillance failure. This method is adaptable to aid in the direction of engineering and statistical reviews to prevent deaths and injuries associated with potential motor vehicle safety defects using available databases.

Accidents, Traffic↗
PubMed2004

Antecedents of fatigue, close calls, and crashes among commercial motor-vehicle drivers.

PROBLEM: Minimizing driver fatigue among commercial motor-vehicle (CMV) drivers is a major safety issue in the United States. This study examines the effects of potentially fatigue-inducing factors inherent in truck driving work and company safety management in explaining: (a) drivers driving while fatigued, (b) the frequency of close calls due to fatigue, and (c) actual crashes among CMV drivers. METHOD: Data for this study are derived from a survey of CMV drivers in 116 trucking firms, with all data being driver-reported. The relative roles of fatigue-inducing factors and safety management practices in explaining variation in fatigue, close calls, and crashes are reported, along with the roles of fatigue in affecting close calls and crashes via hierarchical regression. RESULTS: Findings indicated that fatigue-inducing factors inherent in driving work and safety practices accounted for appreciable variation in driving fatigued (R(2) =.42) and close calls (R(2) =.35), but not crash involvement. Driving while fatigued also accounted for incremental increases in the amount of variation in close calls, after consideration of inherent factors and safety practices. IMPACT ON INDUSTRY: Findings indicate that safety practices (e.g., establishment of a strong safety culture, dispatcher scheduling practices, company assistance with fatiguing behaviors such as loading and unloading) have considerable potential to offset fatigue-inducing factors associated with truck driving work.

Accidents, Traffic↗
PubMed2006

Effects on accidents of periodic motor vehicle inspection in Norway.

An extensive programme of periodic motor vehicle inspection was introduced in Norway after 1995, when the treaty between Norway and the European Union (EU) granting Norway (not a member of the EU) access to the EU inner market took effect (The EEA treaty). This paper evaluates the effects on accidents of periodic inspections of cars. Trucks and buses were not included in the study. Negative binomial regression models were fitted to data on accidents and inspections created by merging data files provided by a major insurance company and by the Public Roads Administration. Technical defects prior to inspection were associated with an increased accident rate. Inspections were found to strongly reduce the number of technical defects in cars. Despite this, no effect of inspections on accident rate were found. This finding is inconsistent with the fact that technical defects appear to increase the accident rate; one would expect the repair of such defects to reduce the accident rate. Potential explanations of the findings in terms of behavioural adaptation among car owners are discussed. It is suggested that car owners adapt driving behaviour to the technical condition of the car and that the effect attributed to technical defects before inspection may in part be the result of a tendency for owners who are less concerned about safety to neglect the technical condition of their cars. These car owners might have had a higher accident rate than other car owners irrespective of the technical condition of the car.

Accidents, Traffic↗
PubMed1984

The role of motor vehicle crashes in causing certain injuries.

Hospital discharge data from Rhode Island were used to assess the role of motor vehicle crashes in causing several types of serious injuries. Motor vehicle crashes were the cause of injury for approximately two-thirds of patients hospitalized with injuries to the chest organs, liver, and spleen, and approximately one-third of those with traumatic pneumothorax or hemothorax, and injuries to the head, kidney, intestine, distal femur, pelvis, and patella.

Accidents, Traffic↗
PubMed1990

The role of motor vehicles in air pollution in the UK.

This paper presents an overview of the contribution of motor vehicles to some air pollution issues in the UK. The coverage of issues is selective concentrating primarily on the motor vehicle's role in emissions of carbon dioxide and other greenhouse gases, NOx concentrations in rural and urban areas. Finally some discussion is given of future technological developments in vehicle pollution control technology and some possible air pollution consequences.

Air Pollution↗
PubMed1995

Mortality patterns among women in the motor vehicle manufacturing industry.

This retrospective follow-up study evaluated the mortality experience of 11,271 women employed in a large motor vehicle manufacturing company in 1973. Company computerized personnel records were used to identify subjects and to obtain their employment histories. Follow-up through December 31, 1985, was conducted using company, state, and national data sources. The mortality rates of the cohort were compared with the rates of the U.S. general population of white or black women, adjusting for age and calendar time and using the standardized mortality ratio (SMR) as the measure of association. The overall mortality rate of the cohort was lower than the U.S. rate by 15% among whites (SMR = 85, 95% confidence interval (CI) = 78-93) and by 40% among blacks (SMR = 59, CI = 49-70). Among whites, the low mortality rate was due primarily to deficits of noncancer deaths, although a 32% deficit also was observed for breast cancer (SMR = 68, CI = 48-92). Black female workers had 40% fewer deaths than expected overall, and their all cancer SMR also was below expectation (SMR = 82, CI = 60-109). Despite evidence of a strong healthy worker effect among women in the motor vehicle manufacturing industry, the study found excesses of lung cancer among white women in assembly jobs (SMR = 158, CI = 107-226) and of pancreatic cancer among white assembly workers in upholstery and trim operations (SMR = 302, CI = 97-704).

Adult↗