Rural Medical College, Loni, India.
BACKGROUND: Road Traffic Accident (RTA) is one among the top five causes of morbidity and mortality in South-East Asian countries.(1) Its socioeconomic repercussions are a matter of great concern. Efficient addressing of the issue requires quality information on different causative factors. RESEARCH QUESTION: What are different epidemiological determinants of RTA in western Nepal? OBJECTIVE: To examine the factors associated with RTA. STUDY DESIGN: Prospective observational. SETTING: Study was performed in a tertiary healthcare delivery institute in western Nepal. PARTICIPANTS: 360 victims of RTA who reported to Manipal Teaching hospital in one year. STUDY VARIABLES: Demographic, human, vehicular, environmental and time factors. Statistical analysis: Percentages, linear and logarithmic trend and Chi-square. RESULTS: Most of the victims i.e. 147 (40.83%) were young (15 to 30 years); from low i.e. 114 (31.66%) and mid i.e. 198 (55%) income families and were passengers i.e. 153 (42.50%) and pedestrians i.e. 105 (29.16%). Sever accidents leading to fatal outcome were associated with personal problems (P<0.01, chi(2)- 8.03), recent or on-day conflicts (P<0.001, chi(2)- 18.88) and some evidence of alcohol consumptions (P<0.001, chi(2)- 30.25). Increased prevalence of RTA was also noticed at beginning i.e. 198 (55%) and end i.e. 69 (19.16%) of journey; in rainy and cloudy conditions (269 i.e. 74.72%) and in evening hours (3 to 7 p.m. 159 i.e. 44.16%). Out of 246 vehicles involved; 162 (65.85%) were old and ill maintained. The contributions of old vehicle to fatal injuries were 33 (50%). Head injury was found in 156 (43.33 %) cases and its associated case fatality rate was 90.90%. In spite of a good percentage receiving first aid i.e. 213 (59.16%) after RTA; there was a notable delay (174 i.e. 48.33% admitted after 6 h) in shifting the cases to the hospitals. The estimated total days lost due to hospital stay was 4620 with an average of 12.83 days per each case. CONCLUSION: Most of the factors responsible for RTA and its fatal consequences are preventable. A comprehensive multipronged approach can mitigate most of them.
Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
Other papers by authors:
Iodine deficiency disorder control programme impact in pregnant women and status of universal salt iodization.
Dept. of Community Medicine, School of Public Health, PGIMER, Chandigarh, 160036, India.
BACKGROUND Several studies pertaining to current status of Iodine Deficiency Disorder Control Programme in India have revealed goiter prevalence in the range of 1.5-44.5%, mean urinary iodine excretion level ranging from 92.5-160 mcg/L and iodized salt coverage ranging from 37-62.3%. Most of these studies were based on school children. However, very few studies have focused on pregnant women. This population is very sensitive to marginalized iodine deficiency throughout their gestational period. METHODS This 40 cluster cross sectional study was done in Raipur district. Iodine content of salt was estimated by using "Rapid Salt Testing Kits" along with observing salt storage practices, at household and in shops. Pregnant women were interviewed by using semi structured comprehensive questionnaire, which was based on knowledge attitude, and practices about salt use pattern and awareness about IDDCP, UIE level were also estimated. RESULTS Prevalence of goiter was 0.17%. Many (41.12%) pregnant women had <15ppm iodine content in the salt sample and 51.58% of women had subnormal iodine uptake. Wrong salt storage practice was observed in 36.3% of households. CONCLUSIONS There were lacunae in Iodine deficiency control program in Chhattisgarh. Implementation and monitoring of program was weak. Thus for monitoring purpose IDD Cell & IDD Laboratory should be established at district level. This will lead to periodic assessment of Iodine Deficiency Disorders, by monitoring of Iodine intake and all other preventive, promotive as well as curative measures in the state.
Badrinarayan Mishra, Sc Mehta, Nidhi Dinesh Sinha, Sushil Kumar Shukla, Nadeem Ahmed, Abhishek Kawatra
Department of Community Medicine, Pravara Institute of Medical Sciences, PMT, Loni, Maharashtra, India.
Healthcare providers being over-worked and under staffed are prone to poor mental health. Unhealthy work place compounds it further. This study was aimed at to assess the mental health status of a medical university employee with special reference to work place stressors. A cross-sectional study was designed and carried out at a Rural Health University. Both the General Health Questionnaire (GHQ)-12 and Holmes-Rahe Scale were used to evaluate 406 participants. Multivariate analysis, correlation, and ANOVA by SPSS 11.0. The minimum age of the participant was 19 years and the maximum 64 years, with an average age at 35.09 years. On the GHQ scale 239(58.9%) recorded psychiatric morbidity out of which 201(49.5%) had moderate and 38(9.3%) severe morbidity. Doctors were the highest stressed group (P ≤ 0.04). Prominent work environmental stressors were poor departmental reorganization, lack of cohesiveness in department, difficult superiors and juniors (P ≤ 0.001, Pearson correlation). Stressors associated with work organization and work nature were: noninvolvement in departmental decision making and lack of proper feedback; along with; work load, lack of clarity in job, and a erratic work schedule (P ≤ 0.001 on Pearson correlation). Harassment, favoritism, discrimination, and lack of self-expression (P ≤ 0.003) were other factors responsible for work dissatisfaction. A high stress level was detected in the study population. The principal stressors were work environment related. Poor work culture was found to lead to job dissatisfaction among majority.
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Socioeconomic inequality and road traffic accidents in Thailand: comparing cases treated in government hospitals inside and outside of Bangkok.
Department of Emergency Medicine, Lerdsin General Hospital, Bangkok, Thailand.
The study aims to report annual demographic characteristics and to compare the differences of socioeconomic inequality, type of motor vehicles, and seating relating to major bone injuries among hospitals in and outside Bangkok. Six public hospitals in Bangkok and six regional hospitals in the provinces were studied over a one year period (2008-2009). There were 3,650 cases: 3,596 injured patients and 54 deaths. Patients with a lower education level accounted for the largest number of cases, both in the provinces (46.3%) and Bangkok (17.1%). Their incomes were less than THB 10,000/yearly. Total number of motorcycle cases (3,360) was higher (11.6:1) than 290 cases of motor vehicles. Pickup cars were used more commonly. Riding a motorcycle was likely to be fatal. The front seat was the most common involvement. Passengers occupying the middle and rear seat of the motorcycle were involved in 16.0% and 1.0% cases, respectively. Long bone and joints were the most common injuries. The results strongly confirmed the striking contribution of motorcycles and pickups to road traffic accidents. People with a low educational level, in conjunction with low income, and in areas outside of Bangkok were more at risk. Specific education on road safety should be delivered, preferably in primary schools.
Epidemiological characteristics of fatal pedestrian accidents in Fars Province of Iran: a community-based survey.
Payam Peymani, Seyed Taghi Heydari, Amin Hoseinzadeh, Yaser Sarikhani, Arya Hedjazi, Mohammad Zarenezhad, Ghasem Moafian, Mohammad Reza Aghabeigi, Najmeh Maharlouei, Ali Foroutan, Seyed Mehdi Ahmadi, Fariborz Ghaffarpasand, Hassan Joulaei, Kamran B Lankarani
Health Policy Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Objective: To determine the epidemiological characteristics of fatal pedestrian accidents in Fars Province of Iran. Methods: This cross-sectional study was conducted in Fars Province of Iran during a 29-month period from March 2009 to July 2011. The data were from the Fars Forensic Medicine Registry. In 4 923 recorded road traffic accident fatalities, 971 deaths were due to pedestrian accidents. The demographic and accident-related information were analyzed by SPSS version 11.5. P value less than 0.05 was considered significant. Results: The mean age of decedents was (47.2+/-26.2) years, ranging from 6 months to 103 years old. Males accounted for 69.8% of all deaths. Fatal accidents were most common in September; 56.1% of the fatal injuries occurred on intracity roads and 33.1% on extracity roads. Fatal head injuries were present in 60.54% of cases. Evaluation of the injury site and the cause of death found that they were significantly associated with age, interval between injury and death. Besides, the type of roads played an important role in mortality. Conclusion: Although the clinical management of trauma patients has been improved in our country in the recent decade, decreasing the burden of injuries needs coordination among trauma system organizations.
Burden of road traffic injuries and related risk factors in low and middle-income Pacific island countries and territories: a systematic review of the scientific literature (TRIP 5).
ABSTRACT: BACKGROUND: In Pacific island countries and territories (PICTs), the burden of road traffic injuries (RTIs) and their attendant risks are considered significant but are poorly quantified. As with other low- and middle-income countries (LMICs), understanding the epidemiology of RTIs in PICTs is critical to informing sustainable research and policy initiatives aimed at reducing this burden. METHODS: We undertook a systematic review and critical appraisal of the relevant epidemiological literature between January 1980 and December 2010, using key search strings for incidence and aetiological studies focussing on RTIs in low and middle-income PICTs. RESULTS: Nineteen studies were identified. The majority were descriptive and were unable to provide population-based estimates of the burden of road crash injury or reliable information on the risk factors using well-designed aetiological research methods. All studies were published more than 10 years ago, and all but three reported on data from Papua New Guinea (PNG), thereby limiting the generalisability of findings to the current status in the region. The PNG studies suggested that RTIs were more frequent among young males, with head injuries the most common cause of death or hospital admission. Two thirds of fatalities occurred at the crash site or soon after admission. Most road crash victims were passengers or pedestrians. Factors postulated to influence the risk of RTIs were travel in open-back utility vehicles, utility vehicle overcrowding, and alcohol. CONCLUSIONS: This review suggests that, despite increasing awareness of the importance of addressing road safety among stakeholders in PICTs, RTI has not been a research priority and there is little relevant current evidence from PICTs to inform policy. Robust epidemiological research that can assess the magnitude and key determinants of RTIs in PICTs is essential to determine context-specific road safety initiatives that are relevant and affordable.
Ann Afr Med. ;11 (3):131-8 22684130
Computerized tomography assessment of cranial and mid-facial fractures in patients following road traffic accident in South-West Nigeria.
Department of Radiology, University College Hospital, Ibadan, Nigeria.
BACKGROUND Globally, the most common cause of cranio-facial fractures is road traffic accident (RTA) with computerized tomography (CT) scan as the gold standard in the diagnosis of patients with cranial and facial fractures. The purpose of this study is to assess the pattern of cranial and facial fractures on CT in head injured patients following RTA. MATERIALS AND METHODS Using CT, detailed analyses of 236 patients with head injury following RTA were performed between 2006 and 2008, Data recorded included cause of injury, age and gender distribution, cranial and mid-facial fractures sustained, associated intracranial and soft tissue injury and the types of vehicular accident. RESULTS The peak age of the patients was between 30 and 39 years. RTA was more common in males than females. Motor-vehicle was the most common cause of RTA in the present study (66.9%). More passengers were involved in the motor vehicle (87.3%) and motorcycle (52.0%) accidents than their corresponding drivers, and they were predominantly males. Majority of the patients involved in pedestrian road traffic accident (PRTA) were motor vehicle victims (93.3%). There were more patients with cranial (59.8%) than mid-facial fractures (40.2%). Majority of the patients had temporal bone cranial fracture (31.1%) and combined or mixed type of mid-facial fractures (41.3%). Intracranial bleeding (31.7%) was the most common associated intracranial finding. CONCLUSION RTAs continue to be a menace and are the main cause of craniofacial injury in Nigeria. This pattern of etiologic factors is in accordance with data from most developing countries. Special attention should be paid to reinforcement of legislation and enactment of laws aimed at the reduction of head injury and provision for easy access to CT for the head injured patient.
Fatal accident distribution by age, gender and head injury, and death probability at accident scene in Mashhad, Iran, 2006-2009.
a Roads & Urban Development Administration of Khorasan Razavi Province , Mashhad , Iran.
Several studies have investigated road traffic deaths, but few have compared by road user type. Iran, with an estimated 44 road traffic deaths per 100,000 population in 2002 had higher road traffic deaths than any other country for which reliable estimates can be made. So, the present study was conducted on road death data and identified fatal accident distribution by age, gender and head injury as well as the influences of age and gender on deaths at accident scenes for all road user groups. Data used in this study are on fatal road accidents recorded by forensic medicine experts of the Khorasan Razavi province in Mashhad, the capital of the province, the second largest city and the largest place of pilgrimage, immigration and tourism in Iran. Chi-square test and odds ratio were used to identify the relation of death place with age and gender in 2495 fatal road accidents from 2006 to 2009. The t-test and analysis of variance were employed for continues variable, age, to compare males' and females' mean age for all road user categories. For two genders, all three groups of fatalities (pedestrian, motorcyclist and motor vehicle occupant) had a peak at the ages of 21-30. The youngest were male motorcyclists (mean age = 28). Old pedestrians were included in road deaths very much, too. Male/female overall ratio was 3.41 and the highest male/female ratio was related to motorcyclists (14). The overall ratio of head injury to other organ injuries (torso and underbody) was 2.51 and pedestrians had the largest amount of head injury (38.2%). Regarding death at accident scene, for all road users, gender did not have any significant relation with death at the scene (P-value > 0.1); on the contrary, age had significant relation (P-value < 0.05). Females were more vulnerable at accident scenes (male/female ratio at accident sense < 1). Pedestrians aged 21-30, motorcyclists 41-50 and motor vehicle occupants 31-40 died the most at accident scenes. Identifying the most endangered groups of road accident fatalities, which was conducted in this study, is invaluable for the appropriate design of prevention strategies and allocation of financial resources for each group of road user fatalities - since in developing nations, there are insufficient financial resources to traffic safety and we should consider superiorities, i.e. the most risky groups. Steps which may contribute to safety promotion for local conditions include suitable facilities for old pedestrians, a training course before obtaining motorcycle license for motorcyclists, informing young road users by provincial media about death risk of road users and improving management of the head-injured patients. Finally, suggestions for future researches were made.
Department of Civil Engineering, National Chi-Nan University, No. 1, University Road, Puli, NanTou Hsien, Taiwan 545. firstname.lastname@example.org
OBJECTIVE To assess the impact of the following factors on rider fatality: rider's age, gender, licensing status, accident liability, use of helmet, alcohol consumption, vehicle class, road conditions, presence of passengers, and passenger injuries. METHODS Data on motorcycle accidents in Taiwan between 2006 and 2008 were analyzed. A logistic regression model was used to establish a fatality risk model for motorcyclists and investigate high-risk factors for motorcyclist fatality. RESULTS Higher fatality rates among motorcycle riders correlate with the following factors: male, older, unlicensed, not wearing a helmet, riding after drinking, and driving heavy (i.e., above 550 cc) motorcycles. In addition, motorcyclists involved in nighttime, nonurban single-vehicle accidents have a higher risk of death, and lone riders have a higher risk of death in accidents than do riders carrying passengers. The seriousness of passenger injury also correlates positively with the rider's risk of death. CONCLUSIONS Nearly 60 percent of all driving fatalities in Taiwan involve motorcycles. Consideration of factors behind the high frequency and risk of motorcycle deaths, specifically rider age above 60 years, not wearing a motorcycle helmet, riding after drinking, and driving without a valid license, could help in the development of effective traffic safety management measures.
Department of Community Medicine, Sri Siddharta Medical College, Tumkur,#79, Laxmi Vaika, Rajaji Nagar, 1st Block, West of Cord Road 1 Main, Bangalore, 560086, Karnataka, India. email@example.com
Injuries now rank among the leading causes of morbidity and mortality the world over. Injuries are steadily increasing in developing countries like India. Systematic and scientific efforts in injury prevention and control are yet to begin in India. Data on injuries are very essential to plan preventive and control measures. The objective of this study is to know the profile of the injury cases admitted to M S Ramaiah hospital, Bangalore, India, using a cross-sectional study design for six months, i.e. from Oct 2008 to April 2009. The mean age of the study population was 35.3 years (SD = 15.38), 69.1% were injured in road traffic accidents (RTA), 28.7% due to falls and 2.2% due to burns. Nearly 14.4% were under the influence of alcohol. Nearly 73.6% of RTA cases were two-wheeler users, 48.5% had not followed sign boards and 56.5% had not obeyed the one-way rules, 63.5% of the two-wheeler users did not use helmets. Also, 38% of two wheelers had two pillion riders, whereas 57% of four-wheeler users had not used a seat belt. Among falls, 58% occurred at home, 49% occurred due to slippery surface. Road traffic accidents were the most common cause for injuries, in which two wheelers were most commonly involved. Strict enforcement of traffic rules and education on road safety are very essential to prevent injuries.
Ir Med J. ;103 (10):303-5 21560501
Department of Neuropathology, Beaumont Hospital, Beaumont, Dublin 9. firstname.lastname@example.org
Excessive drinking increases the risk of dying unnaturally. In the Republic of Ireland such deaths are referred to the State Pathologist. Blood alcohol concentration (BAC) is routinely measured. We created a database of cases presenting to the State Pathologist over a nine year period (2000-2008 inclusive) to evaluate the relationship between alcohol and fatal traumatic brain injuries (FTBI). Of a total of 1778 cases, 332 (275 Male [M]; 57 Female [F]) died of head injuries. Fatalities were highest in males aged 36-50 (N = 97) and 26-35 (N = 73). Assaults (N = 147), falls (N = 95), road traffic accidents (RTA)(N = 50) and suicide (N = 15) were the commonest modes of presentation. A positive blood alcohol concentration (BAC) was found in 36% of assaults, 41% of falls and 40% of suicides. In the RTA group BAC was positive in 59% of pedestrians, 33% of drivers and 14% of passengers. Alcohol clearly plays a significant role in FTBI in the forensic setting.
Fatal traffic injuries among children and adolescents in three cities (capital Budapest, Vilnius, and Tallinn).
Klára Töro, Fehér Szilvia, Dunay György, Alvydas Pauliukevicius, Marija Caplinskiene, Romas Raudys, Delia Lepik, Jana Tuusov, Marika Vali
Department of Forensic and Insurance Medicine, Semmelweis University, 1091-Hungary, Budapest. email@example.com
Motor vehicle accidental injuries are a frequent cause of death among young children and adolescents. The goal of this study was to compare patterns of injury between three capitals (Budapest, Vilnius, and Tallinn). Information on 190 fatal traffic accidents (69 pedestrians, 14 bicyclists, and 107 motor vehicle occupants) between 2002 and 2006 was collected from databases of medico-legal autopsies. The role of victims in accidents, the location of injuries, cause of death, survival period, and blood alcohol levels were evaluated. One-hundred and forty-one (74%) victims had a passive role in traffic as pedestrians, passengers in cars, or public transport. In victims who died at the scene, the rate of head injury was higher than in cases who received medical treatment (odds ratio = 2.58, CI = 1.2-5.55, p = 0.0127). These results underline the importance of postmortem studies to examine the pathomechanism of fatal traffic accidental injuries and to provide information for the prevention of road traffic accidents against children and adolescents.