Search

Background: Claimants with chronically painful injuries sustained in motor vehicle accidents (MVAs) undergo assessment and management influenced by insurance and medico-legal processes defined by a biomedical paradigm which is discordant with best evidence. We aim to demonstrate the impact of biopsychosocial factors on post-MVA sequelae which contribute to non-recovery.Methods: This was a retrospective cohort study of medico-legal documents and reports on 300 consecutive claimants referred to a pain medicine physician over 7 years (2012-2018) for assessment of painful musculoskeletal injuries post-MVA. One hundred data items were extracted from the medico-legal documents and reports for each claimant and entered into an electronic database. Post-MVA sequelae were analysed using chi-square analysis (OR >2) for significant associations with demographic, pre-MVA and post-MVA variables. Factors with significant associations were entered into a logistic regression model to determine significant statistical predictors of post-MVA sequelae contributing to non-recovery.Results: The claimants were aged 17 to 80 years (mean age 42 years), and approximately half (53%, n=159) were female. The time from MVA to interview averaged 2.5 years. Widespread pain was present in 18% (n=54), and widespread somatosensory signs implying central sensitisation (OR=9.85, p<.001) was the most significant multivariate association. Long-term opiate use post-MVA (32%) was predicted by pre-MVA sleep disturbance (OR=5.08, p=.001), post-MVA major depressive disorder (MDD) (OR=3.02, p=.003) and long-term unemployment (OR=2.22. p=.007). Approximately half (47%, n=142) required post-MVA support from a psychologist or psychiatrist. Post-traumatic stress disorder (PTSD) was diagnosed by a psychiatrist or psychologist in 20% (n=59), yet early identification of risk of PTSD was rare. Pre-MVA, 89.4% (n=268) were studying or employed. Permanent unemployability post-MVA occurred in 35% (n=104) and was predicted by MDD (OR=3.59, p=.001) and antidepressant use (OR=2.17, p=.005). Major social change post-MVA (70%) was predicted by older age (OR=.966, p=.003), depressive symptoms (OR=3.71, p<.001) and opiate use (OR=2.00, p=.039).Conclusions: Biomedical factors, including older age, impaired sleep and indicators of widespread central sensitisation, and psychological factors, including stress, anxiety and depression, were the most prominent multivariate associations as statistical predictors of major adverse sequelae contributing to non-recovery for claimants with chronic pain post-MVA. [ABSTRACT FROM AUTHOR]

Highlights • The coordination of gaze and steering was studied in an on-road study. • Drivers often returned their gaze back to the road ahead before making steering corrections. • The eccentricity of the off-road target influences gaze-steering coordination. Abstract In car driving, gaze typically leads the steering when negotiating curves. The aim of the current study was to investigate whether drivers also use this gaze-leads-steering strategy when time-sharing between driving and a visual secondary task. Fourteen participants drove an instrumented car along a motorway while performing a secondary task: looking at a specified visual target as long and as much as they felt it was safe to do so. They made six trips, and in each trip the target was at a different location relative to the road ahead. They were free to glance back at the road at any time. Gaze behaviour was measured with an eye tracker, and steering corrections were recorded from the vehicle's CAN bus. Both in-car ' Fixation ' targets and outside ' Pursuit ' targets were used. Drivers often used a gaze-leads-steering strategy, glancing at the road ahead 200–600 ms before executing steering corrections. However, when the targets were less eccentric (requiring a smaller change in glance direction relative to the road ahead), the reverse strategy, in which glances to the road ahead followed steering corrections with 0–400 ms latency, was clearly present. The observed use of strategies can be interpreted in terms of predictive processing: The gaze-leads-steering strategy is driven by the need to update the visual information and is therefore modulated by the quality/quantity of peripheral information. Implications for steering models are discussed. [ABSTRACT FROM AUTHOR]

Background: Persistent pain and mental health conditions often co-occur after injury, cause enormous disability, reduce social and economic participation, and increase long-term healthcare costs. This study aimed to characterise the incidence, profile and healthcare cost implications for people who have a treated mental health condition, persistent pain, or both conditions, after compensable transport injury.Methods: The study comprised a population cohort of people who sustained a transport injury (n = 74,217) between 2008 to 2013 and had an accepted claim in the no-fault transport compensation system in Victoria, Australia. Data included demographic and injury characteristics, and payments for treatment and income replacement from the Compensation Research Database. Treated conditions were identified from 3 to 24-months postinjury using payment-based criteria developed with clinical and compensation system experts. Criteria included medications for pain, anxiety, depression or psychosis, and services from physiotherapists, psychologists, psychiatrists, and pain specialists. The data were analysed with Cox Proportional Hazards regression to examine rates of treated conditions, and general linear regression to estimate 24 month healthcare costs.Results: Overall, the incidence of treated mental health conditions (n = 2459, 3.3%) and persistent pain (n = 4708, 6.3%) was low, but rates were higher in those who were female, middle aged (35-64 years), living in metropolitan areas or neighbourhoods with high socioeconomic disadvantage, and for people who had a more severe injury. Healthcare costs totalled more than $A707 M, and people with one or both conditions (7.7%) had healthcare costs up to 7-fold higher (adjusting for demographic and injury characteristics) in the first 24 months postinjury than those with neither condition.Conclusions: The incidence of treated mental health and persistent pain conditions was low, but the total healthcare costs for people with treated conditions were markedly higher than for people without either treated condition. While linkage with other public records of treatment was not possible, the true incidence of treated conditions is likely to be even higher than that found in this study. The present findings can be used to prioritise the implementation of timely access to treatment to prevent or attenuate the severity of pain and mental health conditions after transport injury. [ABSTRACT FROM AUTHOR]

Objective: To examine the prevalence and changing patterns of PTSD, major depressive episode (MDE), and generalized anxiety disorder (GAD) in adult claimants who sustained a non-catastrophic injury in a road traffic crash (RTC) in Queensland, Australia.Method: Participants (N = 284) were assessed at approximately 6, 12, and 24 months post-RTC using the composite international diagnostic interview (CIDI) modules for PTSD, and CIDI-short form for MDE, and GAD.Results: The prevalence of at least one of these disorders was 48.2%, 52.5%, and 49.3%, at 6, 12, and 24 months, respectively. Comorbidity was common (20.8% at 6 months, 27.1% at 12 months, and 21.1% at 24 months) and only 33.1% of participants never met PTSD, GAD, or MDE criteria. A substantial proportion of participants (42.3%) had an unstable diagnostic pattern over time. Participants with multiple diagnoses at 6 months were more likely to continue to meet diagnostic criteria for any disorder at 12 and 24 months than participants with a single diagnosis. Participants with PTSD (with or without MDE/GAD) were more likely to meet criteria for any disorder at 24 months than participants with another diagnosis. Preinjury psychiatric history increased the likelihood of any disorder at 24 months post-injury, but did not significantly increase the likelihood of PTSD.Conclusions: People injured in a RTC are at risk of having complex psychological presentations over time. Interventions to prevent mental disorders, especially PTSD, in the early post-injury period are needed to prevent chronic psychological injury, including consideration of comorbidity and dynamic course. [ABSTRACT FROM AUTHOR]

Background: Electric bike (e-bike) usage is growing worldwide, and so is the e-bike-related injury rate.Objective: This study was undertaken to characterize e-bike-related injuries.Methods: Data of all e-bike-related injuries presenting to our level I trauma center between 2014 and 2016 were collected and analyzed. Adult and pediatric (<18 years of age) e-bike-related injuries were then analyzed separately and compared.Results: Forty-eight patients suffering from e-bike-related injuries presented to our trauma center between January 1, 2014 and December 31, 2016. Seventeen (35%) patients were <18 years of age and 40 (85%) were male. The overall most common mechanism of injury was falling off the e-bike in 24 patients (50%), followed by collision with a static object in 9 patients (18.8%). Head (38%) and facial (33%) injuries were most common in children. In adult patients, orthopedic trauma was predominant, with extremity fractures in 35 (73%) followed by significant lacerations in 14 patients (29%). Severe trauma (Injury Severity Score >15) was found in 17 (35%) patients. The duration of hospital stay was 10.8 ± 6 days, 12 patients (25%) required a stay in the intensive care unit, and 21 patients (43.7%) required surgery. Compared to adults, children (<18 years of age) had significantly more head and face injuries (p = 0.05).Conclusion: Our study suggests that e-bike-related trauma may involve serious injuries and have typical injury patterns that resemble those seen in motorcycle-related injuries. Children are more likely to suffer head and face injuries because of their higher head to body ratio. We suggest that these injuries should therefore be triaged appropriately, preferably to a medical facility with proper trauma capabilities. [ABSTRACT FROM AUTHOR]

A timely and accurate acquisition of the information provided by variable message signs (VMS) can be crucial while driving. In the current study, we assess the difficulties of adults with dyslexia acquiring the information shown in VMS and provide evidence to discuss the controversial use of pictograms as potential countermeasures. Twenty-two adults with dyslexia and 22 matched controls completed a simulated driving session. The legibility of 12 VMS was assessed, including six text messages (e.g. "ACCIDENT") and six single pictograms (e.g. the icon for "accident ahead"). On average, participants with dyslexia started reading text messages when they were closer to the VMS. In addition, while approaching text VMS, they dedicated more gazes and manifested worse control of speed. Regarding pictogram VMS, we observed no differences in response distance, accuracy, response duration, or number of gazes. To sum up, the evidence provided reveals that adults with dyslexia, despite potential compensation effects, may still find difficulties reading text messages in VMS (shorter legibility distances, longer reading times, and increased cognitive effort), whereas we found no such differences in the recognition of pictograms (only some difficulties keeping a steady speed). Research on inclusive measures to improve reading in low-skilled or dyslexic drivers must be encouraged. [ABSTRACT FROM AUTHOR]

Background: The relationship between driver blood alcohol concentration (BAC) and crash involvement is well understood. However, the role of alcohol use disorders (AUDs) (i.e., dependence or abuse) in crash occurrence, as distinguished from non-clinical heavy alcohol consumption, has not been adequately explored.Methods: Data from the 2010-2011 Crash Risk Study conducted in Virginia Beach, VA, were used in this study. Drivers involved in crashes were compared with control drivers, and four drinker groups were examined: alcohol dependent, alcohol abusers, heavy drinkers, and all other current (i.e., normative) drinkers. Logistic regression analyses were conducted on two outcomes: having a moderate BAC (≥0.05 g/dl), and crash involvement.Results: Overall, 2411 crash-involved and 5514 control drivers provided useable data, 52.4% of which were men and 70.8% Whites. The prevalence of drivers with AUDs was lower for the crash-involved drivers (8.7%) than for the control drivers (12.7%). Only heavy drinkers, but not abusive or dependent drinkers, were over four times more likely to drive with moderate BACs at nighttime. More important, at nighttime, the odds of crash involvement for dependent drinkers were only one third of those for normative drinkers. Daytime crashes, however, were more likely to involve normative drinkers than any of the other three drinker types.Conclusions: Drivers with AUDs are not more likely than normative drinkers to drive with moderate BACs at night. After accounting for the influence of BAC, dependent drinkers have a lower risk of being involved in a crash, at any time of the day. [ABSTRACT FROM AUTHOR]

Background: The lives of persons who use illicit substances are filled with physical adversities and negative outcomes.Objectives: The purpose of this study was to determine: 1) the frequency of substance-related fights, fractures, and driving accidents in the past year among heroin users entering an inpatient detoxification program, and 2) to determine demographic and recent substance use factors associated with the most common of these physical traumas.Methods: Between May 2015 and December 2015, we surveyed 433 persons entering a short-term inpatient detoxification program that reported heroin use in the last month and recorded their experiences of physical traumas in the last year.Results: Among participants (72% male; 74% heroin injectors), more than a quarter (28.6%) reported a substance-related fight in the past year. Multivariate modeling revealed cocaine use, hazardous alcohol use, and younger age were significantly associated with fighting, but gender was not. Forty-five (10.4%) persons reported a fracture in the past year, with 64% of fractures related to a substance-related fall or fight. Additionally, 9.0% reported being a driver in a car accident after drinking or using drugs in the past year. Trauma rates were not significantly different from a contemporaneous cohort seeking alcohol detoxification at the same facility.Conclusion: Heroin users, both men and women, lead physically traumatic lives, interrupted by interpersonal violence, falls, fractures, and motor vehicle accidents. [ABSTRACT FROM AUTHOR]

Purpose: Individuals who have sustained an injury from a road traffic crash (RTC) are at increased risk for long lasting health problems and non-return to work (NRTW). Determining the predictors of NRTW is necessary to develop screening tools to identify at-risk individuals and to provide early targeted intervention for successful return to work (RTW). The aim of this study was to identify factors that can predict which individuals will not RTW following minor or moderate injuries sustained from a RTC.Method: Participants were 194 claimants (63.4% female) within a common-law "fault-based" system from the UQ SuPPORT cohort who were working prior to their RTC. Participants were assessed at 6 months on a variety of physical and mental health measures and RTW status was determined at 2 years post-RTC. RTW rate was 78.4%.Results: Univariate predictors of NRTW included being the driver or passenger, having a prior psychiatric diagnosis, high disability level, low mental or physical quality of life, predicted non-recovery, high pain, low function, high expectations of pain persistency, low expectations about RTW, having a psychiatric diagnosis, elevated depression or anxiety. The final multivariable logistic regression model included only two variables: disability level and expectations about RTW. Seventy-five percent of individuals who will not RTW by 2 years can be identified accurately at an early stage, using only these two predictors.Conclusion: The results are promising, because they suggest that having information about two factors, which are easily obtainable, can predict with accuracy those who will require additional support to facilitate RTW. [ABSTRACT FROM AUTHOR]

Background: The majority of crashes cause "minor" injuries (i.e., treated and released from the emergency department [ED]). Minor injury crashes are poorly studied.Objectives: This study aims to determine the prevalence of driver-related risk factors and subsequent outcome in drivers involved in minor crashes.Methods: We interviewed a convenience sample of injured drivers, aged over 17 years, who were treated and released from the ED. Follow-up interviews were conducted 6 months after the crash.Results: We approached 123 injured drivers; baseline interviews were completed in 69 and follow-up interviews in 45. Prior to the index crash, 1.4% of drivers drank alcohol, 1.4% used illicit drugs, and 7.2% used sedating prescription medications. Nine drivers (13%) were distracted. In this sample, 5.8% met criteria for being aggressive drivers, 7.2% were risky drivers, and 11.6% drove while experiencing negative emotions. At 6-month follow-up, many drivers were still having health problems, 53.3% were not fully recovered, 46.7% had not returned to usual activities, and 28.9% were off work. Of the 42 participants who resumed driving, 16.7% had a near miss and 4.8% had another crash. Nine (21.4%) reported drinking and driving, and 9.5% reported driving after cannabis use. Cell phone use (16.7%) and use of other electronics while driving (23.8%) were also common.Conclusions: Driver-related risk factors are common in drivers involved in minor injury crashes, and drivers persist in taking risks after being involved in a crash. Despite their name, minor injury crashes are often associated with slow recovery and prolonged absenteeism from work. [ABSTRACT FROM AUTHOR]

There are well-documented associations between posttraumatic stress disorder (PTSD) symptoms and intimate relationship impairments, including dysfunctional communication at times of relationship conflict. To date, the extant research on the associations between PTSD symptom severity and conflict communication has been cross-sectional and focused on military and veteran couples. No published work has evaluated the extent to which PTSD symptom severity and communication at times of relationship conflict influence each other over time or in civilian samples. The current study examined the prospective bidirectional associations between PTSD symptom severity and dyadic conflict communication in a sample of 114 severe motor vehicle accident (MVA) survivors in a committed intimate relationship at the time of the accident. PTSD symptom severity and dyadic conflict communication were assessed at 4 and 16weeks post-MVA, and prospective associations were examined using path analysis. Total PTSD symptom severity at 4weeks prospectively predicted greater dysfunctional communication at 16weeks post-MVA but not vice versa. Examination at the level of PTSD symptom clusters revealed that effortful avoidance at 4weeks prospectively predicted greater dysfunctional communication at 16weeks, whereas dysfunctional communication 4weeks after the MVA predicted more severe emotional numbing at 16weeks. Findings highlight the role of PTSD symptoms in contributing to dysfunctional communication and the importance of considering PTSD symptom clusters separately when investigating the dynamic interplay between PTSD symptoms and relationship functioning over time, particularly during the early posttrauma period. Clinical implications for the prevention of chronic PTSD and associated relationship problems are discussed. [ABSTRACT FROM AUTHOR]

The aim of this study was to characterize different possible profiles of emotional experiences of victims of traffic accident based on verbatim accounts collected one year after the accident, and to relate these profiles to various socio-demographic and health data. A hierarchical cluster analysis of the emotional lexicon was made by categorizing and quantifying the EMOTAIX© lexicon using Tropes© text analysis software. Out of the 751 selected subjects, 328 expressed one or more emotional experiences. A link appeared between quality of life (QoL), post-traumatic stress disorder (PTSD) and the valence of expressed emotions. Injury severity and history distinguished two sets expressing negative-valence emotional experience. Paradoxically, a group also emerged with a large proportion of severely injured persons, associated with the expression of positive-valence emotional experiences and with domains of QoL and PTSD. The analysis of subjective data sheds light on the experience of traffic accident victims and shows a way forward for research and clinical intervention. [ABSTRACT FROM AUTHOR]

The current study aimed to follow-up a group of road crash survivors for one year and assesses the impact of injury on their psychological and physical condition. All crash survivors that were admitted to the intensive or sub-intensive care units of selected hospitals in Greece, Germany and Italy over one year period (2013-2014), were invited to participate in the study and were interviewed at three different time-points as follows: (a) at one month (baseline data), (b) at six months, and (c) at twelve months. The study used widely recommended classifications for injury severity (AIS, MAIS) and standardized health outcome measures such as the Disability Assessment Schedule II (WHODAS 2.0) to measure disability, "Impact of Event Scale" (IES-R) to measure Post-Traumatic Stress Disorder (PTSD), Center for Epidemiological Studies Depression Scale (CES-D Scale) to measure depression. A total of 120 patients were enrolled in the study in all the partner countries and 93 completed all follow up questionnaires. The risk of physical disability was 4.57 times higher [CI 1.98-2.27] at the first follow up and 3.43 times higher [CI 1.43-9.42] at the second follow up as compared with the time before the injury. There was a 79% and an 88% lower risk of depression at the first and the second follow up respectively, as compared with the baseline time. There was also a 72% lower risk of Post-Traumatic Stress at the second follow up as compared with the baseline time. A number of factors relevant to the individuals, the road crash and the injury, were shown to distinguish those at higher risk of long-lasting disability and psychological distress including age, marital status, type of road user, severity and type of the injury, past emotional reaction to distress. The study highlights the importance of a comprehensive and holistic understanding of the impact of injury on an individual and further underlines the importance of screening and treating psychological comorbidities in injury in a timely manner. [ABSTRACT FROM AUTHOR]

Introduction: Psychological distress following a motor vehicle crash (MVC) is prevalent, especially when the person sustains an associated physical injury. Psychological distress can exhibit as elevated anxiety and depressive mood, as well as presenting as mental disorders such as Post Traumatic Stress Disorder (PTSD) or Major Depressive Disorder (MDD). If unmanaged, psychological distress can contribute to, or exacerbate negative outcomes such as social disengagement (e.g., loss of employment) and poor health-related quality of life, as well as contribute to higher costs to insurers. This systematic review summarises current research concerning early psychological intervention strategies aimed at preventing elevated psychological distress occurring following a MVC.Method: A systematic review of psychological preventative intervention studies was performed. Searches of Medline, Embase, PsychINFO, Web of Science and Cochrane Library were used to locate relevant studies published between 1985 and September 2015. Included studies were those investigating MVC survivors who had received an early psychological intervention aimed at preventing psychological distress, and which had employed pre- and post- measures of constructs such as depression, anxiety and disorders such as PTSD.Results: Searches resulted in 2608 records. Only six studies investigated a psychological preventative intervention post-MVC. Interventions such as injury health education, physical activity and health promotion, and therapist-assisted problem solving did not result in significant treatment effects. Another six studies investigated psychological interventions given to MVC survivors who were assessed as sub-clinically psychologically distressed prior to their randomisation. Efficacy was varied, however three studies employing cognitive behaviour therapy (CBT) found significant reductions in psychological distress compared to wait-list controls.Conclusion: Psychological interventions aimed at preventing psychological distress post-MVC are limited, often involving small samples, with subsequent poor statistical power and subsequent high risk of bias. These factors make it difficult to draw conclusions, however CBT appears encouraging and therefore worthy of consideration as a preventative intervention. [ABSTRACT FROM AUTHOR]

Background: Substance use disorders are associated with the increased risk of driving under the influence (DUI), but little is known about crack-cocaine and its relationship with road traffic crashes (RTC).Method: A multicenter sample of 765 crack-cocaine users was recruited in six Brazilian capitals in order to estimate the prevalence of DUI and RTC involvement. Legal, psychiatric, and drug-use aspects related with traffic safety were evaluated using the Addiction Severity Index - 6th version (ASI-6) and the Mini International Neuropsychiatric Interview.Results: Seventy-six (28.3%) current drivers reported accident involvement following crack-cocaine use. Among drivers (n=269), 45.7% and 30.5% reported DUIs in the past 6 months and 30 days, respectively. Drivers reporting DUI's in the past month (n=82) had higher scores in the "psychiatric", "legal", and "family problems" subscales from the ASI-6, and lower scores in the "family social support" subscale in comparison to those without a history of DUIs (n=187). An overall high prevalence of psychiatric comorbidity and substance consumption was observed. Participants with 5+ years of crack-cocaine use were more likely to have been in a RTC (RR=1.52, 95%IC: 1.02-2.75), independently of marijuana use, binge drinking and psychiatric comorbidities.Conclusion: The high prevalence of RTC and DUI involvement among crack-using drivers supports the idea that they are at a high risk group regarding traffic safety. Years of crack consumption seem to be associated with RTC involvement. Also, the presence of psychiatric comorbidities, poly-drug use, and cognitive impairment usually associated with crack addiction could yield additional risk of accidents. [ABSTRACT FROM AUTHOR]

Posttraumatic stress disorder (PTSD) symptoms describe a common chronic and disabling reaction of individuals exposed to extreme stress. The negative influence of PTSD on people's functioning justifies researchers' efforts to define predictors of the disorder and the factors that can prevent the development of PTSD. Existing research exposes a pronounced role of temperamental traits, in addition to the severity of trauma exposure. Experience of the traumatic event and subjective assessment of its consequences may also be influenced by individual differences in the time perspective profile, particularly the indicator of temporal adaptation referred to as balanced time perspective (BTP). The aim of the present research was to establish the relationship between time perspective, trauma exposure and temperament and its influence on the level of PTSD symptoms. The regression analyses showed that briskness, emotional reactivity, BTP and trauma severity were significant predictors of PTSD symptoms and that BTP mediated the relationship between temperament and PTSD. People exposed to more severe trauma who were prone to strong emotional reactions and were less flexible in coping with trauma revealed a negatively biased time perspective, which resulted in the development of PTSD symptoms. [ABSTRACT FROM AUTHOR]

Psychological symptoms are common among burn survivors. However, knowledge about epidemiology and predictors of psychopathology has shown great heterogeneity in this population. The Fenix-II Project was the first epidemiological study on the psychopathological consequences of burns developed in Spain, providing a detailed analysis of the progression of psychological symptoms during the first six months after injury. Three hundred and thirty-three patients were screened and 183 were included in this study. Posttraumatic, depression and anxiety symptoms showed a general decreasing tendency across time. At 6 months, 34 patients showed clinically significant Posttraumatic Stress Disorder (PTSD) symptoms (20.5% of 166 patients reached at 6 months) as assessed with the MINI Neuropsychiatric Interview. Within this group of patients, anxiety, depression and hyperarousal increased at 30 days, and avoidance 90 days after injury. The most accurate predictors of PTSD were found to be being burned in a Motor Vehicle Crash, risk of social exclusion, low body-image adjustment, anterior trunk location of the burn and life threat perception during the burn-shock period. Considering these factors, clinicians may identify patients at risk of PTSD development, allowing an adequate follow up and preventive interventions which may minimize the psychological consequences of burns. [ABSTRACT FROM AUTHOR]

Introduction: Bicycle crashes often affect individuals in working age, and can impair quality of life (QoL) as a consequence. The aim of this study was to investigate QoL in bicycle trauma patients and to identify those at risk of impaired QoL.Patients and Methods: 173 bicycle trauma patients who attended a level I trauma centre from 2010 to 2012 received Hadorn's QoL questionnaire six months after their crash. Medical data was collected from the patient's records. Univariate ordinal logistic regression was used to investigate the association between QoL and other factors.Results: 148 patients returned the questionnaire (85.5%). The majority had only mild or minor injuries (85.1%; n=126). However, 72.1% (n=106) still suffered from pain or other physical symptoms more than six months after their bicycle crash. Patients with a Glasgow Coma Scale (GCS) ≤13 or an Injury Severity Score (ISS) >15 experienced impaired emotions/outlook on life (p-values 0.003 and 0.045, respectively). Physical suffering was reported by patients with a GCS ≤13 and in those with injuries to the cervical spine (p-values 0.02 and 0.025, respectively). Patients with an ISS >15 or facial fractures experienced limitations in daily activities (p-values 0.031 and 0.025, respectively).Conclusions: More than 70% of bicycle trauma patients suffered physically more than six months after their crash, even though only 15% were severely injured. Risk factors for an impaired QoL were cervical spine injuries or facial fractures, a GCS ≤13 and an ISS >15. [ABSTRACT FROM AUTHOR]

The relationship between short-term macroeconomic growth and temporary mortality increases remains strongest for motor vehicle (MV) crashes. In this paper, I investigate the mechanisms that explain falling MV fatality rates during the recent Great Recession. Using U.S. state-level panel data from 2003 to 2013, I first estimate the relationship between unemployment and MV fatality rate and then decompose it into risk and exposure factors for different types of MV crashes. Results reveal a significant 2.9 percent decrease in MV fatality rate for each percentage point increase in unemployment rate. This relationship is almost entirely explained by changes in the risk of driving rather than exposure to the amount of driving and is particularly robust for crashes involving large commercial trucks, multiple vehicles, and speeding cars. These findings provide evidence suggesting traffic patterns directly related to economic activity lead to higher risk of MV fatality rates when the economy improves. [ABSTRACT FROM AUTHOR]

Training programs exist that prove effective at teaching novice drivers to anticipate latent hazards (RAPT), mitigate hazards (ACT) and maintain attention (FOCAL). The current study (a) measures the effectiveness of a novel integrated training program (SAFE-T) that takes only a third as long to complete compared to the three individual training programs and (b) determines if integrating the training of all the three higher cognitive skills would yield results comparable to the existing programs. Three groups were evaluated: SAFE-T, RAPT and Placebo. The results show that the drivers in the SAFE-T-trained group were more likely to anticipate hazards, quicker and more effective at responding to hazards, and more likely to maintain glance durations under a critical threshold of 2 s as compared to drivers in the Placebo-trained group who received a control program that does not actively train on any of the three cognitive skills. Moreover, the results show that the drivers in the SAFE-T trained group were just as likely to anticipate hazards as the drivers in the RAPT trained group. Finally, when compared with prior studies, the drivers in the SAFE-T trained group showed similar effects of attention maintenance training. [ABSTRACT FROM AUTHOR]

Purpose: To determine which distracted driving laws were associated with decreased texting while driving among U.S. teenage drivers.Methods: Data from the 2013 Youth Risk Behavior Surveillance System survey were merged with states' distracted driving legislation. The prevalence of texting while driving was assessed for different laws using log-binomial regression.Results: Approximately 39.0% of students reported texting while driving at least once in the 30 days before survey. Compared to states with universal texting bans along with young driver all cellphone bans, the adjusted ratio of texting while driving was 0.94 (95% confidence interval [CI], 0.77-1.16) in states with no bans, 1.33 (95% CI, 1.11-1.58) for young driver bans only, 1.24 (95% CI, 1.00-1.52) in states with bans for young drivers but no young driver all cellphone bans, and 0.89 (95% CI, 0.66-1.19) in states with universal texting bans. The prevalence of texting was 28% less in states with delays of full licensure for texting offenses (prevalence ratio = 0.72; 95% CI, 0.59-0.88).Conclusions: Universal texting bans along with young driver all cellphone bans may be more effective in reducing texting while driving. Delays of full licensure may dissuade young drivers from texting and driving. [ABSTRACT FROM AUTHOR]

Background: Aberrant brain functional and structural changes are considered to be one of the important mechanisms underlying post-traumatic stress disorder (PTSD). However, it remains unclear whether inter-hemispheric connection is changed. The current study aimed to identify the inter-hemispheric functional and anatomical connectivity changes in patients who consequently develop PTSD using the voxel-mirrored homotopic connectivity (VMHC) analysis and diffusion tractography techniques.Methods: Resting-state fMRI and DTI data were acquired on victims who had experienced traffic accidents within 2 days after the traumatic event. The diagnosis was made using the Clinician-Administered PTSD Scale at 1 or 6 months later. Fifteen trauma-exposed victims met the criteria for diagnosis of PTSD and 14 trauma-exposed victims who did not develop PTSD at 6 months after trauma were selected as the control group.Results: Compared with the victims without PTSD, the victims with PTSD exhibited an abnormal homotopic pattern with decreased VMHC in the superior/middle frontal gyrus before diagnosis. The regions showing abnormal functional connectivity were then chosen as regions of interest for an analysis of DTI tractography. Decreased fractional anisotropy values in the genu of the corpus callosum were found in the victims with PTSD. Greater WM disruptions within 2 days predicted greater symptom severity at diagnosis.Limitations: The study was lack of comparison with controls who did not experience a traumatic event.Conclusion: Our results suggest that the inter-hemispheric functional and structural connectivity is impaired in PTSD within 2 days, which may be the potential marker showing predisposition towards developing PTSD. [ABSTRACT FROM AUTHOR]

A number of studies have been done to investigate the role of brain-derived neurotrophic factor (BDNF) in patients with post-traumatic stress disorder (PTSD). In this study we aimed to test the relationship between plasma BDNF levels and PTSD. We solicited 65 subjects having recently experienced road traffic accidents (RTA) conforming to screening criteria. They were given follow-up examinations after one month, three months, and six months. PTSD was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-R-TR, American Psychiatric Association, 2000) using the Mini International Neuropsychiatric Interview (MINI). All participants were divided into two groups: a group with PTSD and a group without PTSD. There were no significant differences in plasma BDNF levels between the two groups at either the 48 h or six-month examination. Within the PTSD group, no significant differences were found in plasma BDNF levels between the two examinations. BDNF levels in those without PTSD showed a higher trend over time after trauma. Higher BDNF levels may be an important protective factor for the prevention of traumatized subjects from developing PTSD. [ABSTRACT FROM AUTHOR]

Highlights: [•] Research and countermeasures focus on broadly addressing the ‘young driver problem’. [•] Young driver crash statistics suggests ‘problem young drivers’ also merit attention. [•] Step 1 is identifying drivers: behaviours and psychosocial factors are suggested. [•] Step 2 is deciding what to do and when: early, multifaceted efforts are required. [•] Targeted countermeasures require development, implementation and evaluation. [ABSTRACT FROM AUTHOR]

Abstract: The present study investigated the consequences of different forms of emotion regulation. Eighty nine healthy participants viewed a distressing video of the aftermath of road traffic accidents under either suppression (of both felt and expressed affect), acceptance, or no-regulation control instructions and the immediate and longer-term consequences on emotion, mood, and memory were examined. Suppression (relative to control) led to reduced subjective experience of fear when viewing the video, but did not alter electrodermal (EDA) or heart rate (HR) response. Subsequently, suppression led to a less marked subjective emotional reaction to positive but not negative emotional images, reduced free recall memory of the video, and a greater likelihood of experiencing zero intrusions of the video''s content. Acceptance (relative to control) had no impact when viewing the video, was associated with a less marked increase in EDA activity in the 5 min period immediately after viewing the video, a more marked HR deceleration and EDA response to both positive and negative images, and elevated negative affect at one week follow-up. These findings suggest, contrary to the current clinical zeitgeist, that emotion suppression can successfully lead to an ongoing down-regulation of emotion and memory, whereas acceptance may elevate subsequent emotionality. [Copyright &y& Elsevier]

Objective: To validate an Italian version of the Impact of Event Scale (IES) in patients addressing the emotional impact of a recent road accident.Methods: Seventy-nine subjects were examined within 1-34 weeks after an accident by means of (1). an Italian version of the IES, (2). a free description of the accident, and (3). a questionnaire assessing subjects' behaviour and feelings.Results: IES data were analysed by means of the principal component analysis (PCA) method, followed by a quartimax rotation, obtaining a two-factor solution interpreted as intrusion (Factor 1) and avoidance (Factor 2). Furthermore, the scores to the two subscales were considered in order to assess their predictive value on some variables linked to the traumatic event. Intrusion significantly discriminated the emotional intensity and fear level of subjects as a consequence of the accident.Conclusions: The IES is a two-dimensional test capable of evaluating posttraumatic stress. The intrusion and avoidance factors explained 40% of the total variance. The two-factor solution has a psychological counterpart and is similar to the findings of earlier studies conducted on a larger number of subjects in other countries. [ABSTRACT FROM AUTHOR]

Presents information on a study on the prediction of who first suffers psychological trauma in the first year after a road accident. Related studies on the psychological aftermath of motor vehicle accidents; Methodology; Results and discussion.

Background: Posttraumatic stress disorder (PTSD) can arise as a reaction to a traumatic experience. While many data concerning PTSD in severely injured patients are available, little is known about this disease in slightly injured patients after road traffic accidents. It is rather assumed that PTSD does not exist after objectively slight injuries.Methods: In total, 36 patients (Injury Severity Score < 16) after road traffic accidents were included in this prospective cohort study. Next to demographic and accident-specific data, the PDI (Peritraumatic Distress Inventory: individual experienced distress directly during or immediately after the traumatic event), THQ (Trauma History Questionnaire) and the BDI-II (Beck Depression Inventory-II: self-report measurement tool to examine the severity of depression) were assessed immediately after trauma (t0). Six weeks (t1) and 3 months (t2) after trauma the Impact of Event Scale - Revised (IES-R), a screening instrument for PTSD, and the BDI-II were collected.Results: Overall 2 patients showed critical measurement values in IES-R after 6 weeks. A strong correlation between PDI and IES-R at t1 and t2 could be detected (p < 0.05). Furthermore, a significant correlation of BDI-II and IES-R after 6 weeks and 3 months was found (p < 0.05). Neither age or sex showed a significant correlation to IES-R (p ≥ 0.05).Conclusion: The present study showed that symptoms of PTSD can also occur after minor trauma. Especially high peritraumatic distress is associated with developing a PTSD. The occurrence of PTSD should be considered not only in severely injured patients, but also in slightly injured patients after road traffic accidents. [ABSTRACT FROM AUTHOR]

Drivers' non-compliance with rules is a prominent factor in collisions with trains at railway level crossings. Road user impatience and frustration has been identified as an underlying factor in non-compliance and can be characterised as a specific risk factor. However, research on non-compliance related to waiting times and driver inconvenience lacks in the literature. This paper, therefore, seeks to enhance the currently limited understanding of the relationship between waiting times and risky driver behaviour. An Advanced Driving Simulator was used to obtain objective measures of level crossing non-compliance. Subjective measures on driver frustration and decision-making processes were also collected. Sixty participants completed six driving tasks each, with the tasks varying in terms of traffic conditions, number of trains and associated waiting times. This study shows that increased waiting times result in higher levels of frustration and an increased likelihood of risky driving behaviour, particularly for waiting times longer than 3 min. Non-compliance included entering the activated crossing before boom gates are down, entering the crossing after the train passage but before signals are deactivated, stopping/reversing on the crossing. Subjective data revealed that participants did not comply with level crossing rules due to factors including time pressure, impatience/frustration and low perceived risk. The results suggest that, where possible, waiting times should be standardised at values lower than 3 min to reduce the likelihood of risky road user behaviour. [ABSTRACT FROM AUTHOR]

Presents an abstract of the article `Stress, Violations and Accidents,' by L. R. Hartley and J. El Hassani, which appeared in the `Applied Ergonomics.' Investigation on the sources of stress among Western Australian drivers; Associations between reported stress and drivers' accident or violation records.

Older drivers have difficulties at intersections, especially in their performance of left turns. Older females are especially at risk in intersection maneuvers. Information processing abilities have been most promising in explaining the crash involvement of elderly drivers. This study examines the relationship of field dependence, visual search skills, and working memory to the decision to make a left turn at an intersection as well as to gap choice. Participants included thirty-three women ranging in age from 61 to 84 years. The results show that working memory plays a very important role in left-turn performance. Implications for appropriate interventions are discussed. Keywords: Working memory; Reaction time; Older drivers; Left turn