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The year 2020 is an extremely unusual year. The world lost more than one million lives due to the attack of COVID-19. Economic production has been greatly reduced, and daily activities are largely restricted. Luckily the work of Chinese Journal of Traumatology (CJTEE) has not been adversely affected. 2020 is a harvest year for the journal, which (1) was included in the high-quality academic journals by China Association for Science and Technology; (2) cover of each issue is newly designed; (3) submission increased by about 60% with more countries and regions covered; (4) usage in the ScienceDirect database exceeded a million; (5) the CiteScore rises to more than 2.0 the first time. This study reviewed the articles published in the year 2020 by CJTEE.

Purpose To evaluate the significance of vision-related problems in fatal motor vehicle accidents (FMVAs) based on a systematic investigation process by multidisciplinary road accident investigation teams (RAITs). Methods Retrospective registry-based study of all FMVAs during the years 2012-2016 in Finland in which driver causing the accident had a valid Finnish driving licence and the operated motor vehicle required having a driving licence. Results There were a total of 968 FMVAs. In only 1.3% of all the accidents, a vision-related problem was considered to have contributed to the FMVA, while an observational failure of 23.6% was the leading cause of all the FMVAs. Conclusions Eye-originating vision problems are rarely a causative risk for FMVAs in Finland. Making current visual standards more stringent would unlikely to be effective in FMVA prevention.

The purpose of this study was to compare the driving simulator performance of participants with visual field loss (VFL) from optic disc drusen (ODD) with a normally sighted control group and a group of individuals with glaucoma. Data on performance and safety from a traffic simulator test for five participants with VFL from ODD were retrospectively compared with data from 49 male individuals without visual deficits in a cross-sectional study. VFL of the ODD group was also compared with a group of 20 male glaucoma participants who had failed the same simulator test. Four individuals with ODD regained their driving licences after a successful simulator test and were then followed in a national accident database. All participants with ODD passed the test. No significant differences in safety or performance measures were detected between the normally sighted participants and the ODD group despite severe concentric visual field constrictions. Compared with failed glaucoma male participants, the ODD group had even lower mean sensitivity in the peripheral and peripheral inferior field of vision. None of the four participants with a regained licence were involved in a motor vehicle accident during a 3-year follow-up period after the simulator test. Despite having severe VFL, participants with ODD had no worse performance or safety than controls. As even individuals with severe VFL might drive safely, there is a need for individual practical assessments on licencing issues.

It is well known that traffic injuries still represent one of the main causes of death and that high blood alcohol concentrations while driving significantly increase the occurrence of accidents. However, only limited literature on the correlation between chronic alcohol abuse and accident risk is available. The aim of the present study was to investigate the hypothesis of an association between elevated concentrations of carbohydrate deficient transferrin (CDT) and the occurrence of alcohol-related traffic accidents.The analytical determinations of BAC and CDT were performed following certified methods in HS-GC-FID and HPLC, respectively. For BAC, 0.50 g/L was used as cut-off, whereas 2.0% was used for CDT, according to the standardisation proposed by IFCC. A total of 929 drivers, tested for BAC at the time of hospital admission after a traffic accident, were classified into two groups: InjDr 1 (BAC ≤ 0.50 g/L) and InjDr 2 (BAC0.50 g/L); all drivers were also tested for CDT.InjDr 1 included 674 individuals, only 2.5% showing a CDT above the cutoff, whereas InjDr 2 group consisted of 255 subjects, 28.6% testing positive for CDT (Odds Ratio 15.5). When subdividing the InjDr group into increasing classes of CDT, a steady increase in the percentage of BAC-positive drivers was appreciated. Moreover, average BAC was found to parallel each class of CDT.The reported data strongly support the use of CDT as a biomarker of increased risk of alcohol-related traffic accidents in the procedures of re-granting of the driving license upon confiscation for "drink driving".

The aim of this study is to share an experience report on the realization of the traffic medicine and first aid module of a traffic instructor training course. It is an experience report, with a qualitative, descriptive and exploratory approach, with participants, 13 students from the traffic medicine module and first aid from a traffic instructor training course. Data collection took place through a questionnaire, which was subsequently analyzed with approximations from Bardin's Content Analysis (2016). Throughout the research, ethical guidelines for research with human beings were followed and respected. The results followed the transversality of the module, intuiting about the interaction of the participants with the classes, discussing the methodology used and the presence of aspects of the relationship between theory and practice. It was also observed the interrelation of the content presented and the importance for personal life. Also, the importance of the module for professional training was identified, under the premise of quality in teaching future vehicle drivers. Thus, it is understood the importance of the module of traffic medicine and first aid for the training of the traffic instructor, being a fundamental profession for the training of vehicle drivers. El objetivo de este estudio es compartir un informe de experiencia sobre la realización de la medicina de tránsito y el módulo de primeros auxilios de un curso de capacitación para instructores de tránsito. Es un informe de experiencia, con un enfoque cualitativo, descriptivo y exploratorio, con participantes, 13 estudiantes del módulo de medicina de tránsito y primeros auxilios de un curso de capacitación para instructores de tránsito. La recopilación de datos se realizó a través de un cuestionario, que posteriormente se analizó con aproximaciones del Análisis de contenido de Bardin (2016). A lo largo de la investigación, se siguieron y respetaron las pautas éticas para la investigación con seres humanos. Los resultados siguieron la transversalidad del módulo, intuyendo sobre la interacción de los participantes con las clases, discutiendo la metodología utilizada y la presencia de aspectos de la relación entre la teoría y la práctica. También se observó la interrelación del contenido presentado y la importancia para la vida personal. Además, se identificó la importancia del módulo para la formación profesional, bajo la premisa de calidad en la enseñanza de los futuros conductores de vehículos. Así, se entiende la importancia del módulo de medicina del tráfico y primeros auxilios para la formación del instructor de tráfico, siendo una profesión fundamental para la formación de conductores de vehículos. O objetivo deste estudo é compartilhar um relato de experiência sobre a realização do módulo de medicina de tráfego e primeiros socorros de um curso de formação em instrutor de trânsito. Trata-se de um relato de experiência, com abordagem qualitativa, descritiva e exploratória, tendo como participantes, 13 estudantes do módulo de medicina de tráfego e primeiros socorros de um curso de formação em instrutor de trânsito. A coleta de dados ocorreu por meio de questionário, sendo posteriormente analisado com aproximações da Análise de Conteúdo de Bardin (2016). Durante toda a pesquisa, foram seguidos e respeitados os preceitos éticos para pesquisas com seres humanos. Os resultados seguiram a transversalidade do módulo, intuindo sobre a interação dos participantes com as aulas, discutindo a metodologia empregada e a presença de aspectos da relação entre teoria e prática. Observou-se também a inter-relação do conteúdo apresentado e a importância para a vida pessoal. E também, identificou-se a importância do módulo para a formação profissional, sob a premissa da qualidade em ensinar os futuros condutores de veículos. Sendo assim, compreende-se a importância do módulo de medicina de tráfego e primeiros socorros para a formação do instrutor de trânsito, sendo uma profissão fundamental para a formação de condutores de veículos.

Driving under the influence of alcohol (DUIA) and drugs (DUID) is considered an elevated risk for traffic safety. When assessing a driver's fitness to drive, standardized and objective measurement methods are still required, in order to clarify the question whether an individual is under the influence of substances acting on the central nervous system (CNS). We exposed healthy test subjects (n = 41) as well as persons who were under the influence of cannabis after repeated inhalation to multiple light stimuli using infrared technology and measured the pupillary light reflex (PLR). Toxicological tests of blood samples taken from every subject followed. The aims of this study were to assess the differences in pupillography response between cannabis consumers after a washout period and no cannabis consumers as well as the dose related effects on pupillography parameters of cannabis in cannabis consumers. All four pupillary parameters changed according to a weakened pupil function after acute administration of cannabis in all test subjects. Furthermore, it could be observed that habitual cannabis consumers showed an altered pupillary function just before the first dose was taken, suggesting that the long-term effects and addiction also have to be taken into account, when effects of the CNS are discussed. The results of the present study show that almost all pupil parameters could be reliable indicators for the detection of subjects under the acute effect of cannabis. (VLID)5800121

Driving under the influence of alcohol (DUIA) and drugs (DUID) is considered an elevated risk for traffic safety. When assessing a driver's fitness to drive, standardized and objective measurement methods are still required, in order to clarify the question whether an individual is under the influence of substances acting on the central nervous system (CNS). We exposed healthy test subjects (n=41) as well as persons who were under the influence of cannabis after repeated inhalation to multiple light stimuli using infrared technology and measured the pupillary light reflex (PLR). Toxicological tests of blood samples taken from every subject followed. The aims of this study were to assess the differences in pupillography response between cannabis consumers after a washout period and no cannabis consumers as well as the dose related effects on pupillography parameters of cannabis in cannabis consumers. All four pupillary parameters changed according to a weakened pupil function after acute administration of cannabis in all test subjects. Furthermore, it could be observed that habitual cannabis consumers showed an altered pupillary function just before the first dose was taken, suggesting that the long-term effects and addiction also have to be taken into account, when effects of the CNS are discussed. The results of the present study show that almost all pupil parameters could be reliable indicators for the detection of subjects under the acute effect of cannabis.

Hintergrund: Um die Fahrtüchtigkeit eines Teilnehmers am Straßenverkehr evaluieren zu können, sind objektive und standardisierte Messmethoden notwendig. Auf die Anwendbarkeit und Wertigkeit der Infrarot-Pupillographie als objektive Messmethode für die Erkennung einer etwaigen Beeinflussung durch zentral-nervös wirksame Substanzen wurde bereits in mehreren Publikationen eingegangen. Ziel der Arbeit: Um an erste Ergebnisse unserer Studie anzuknüpfen war Ziel dieser Arbeit, die statistische Analyse auf weitere Parameter des Pupillenlichtreflexes (PLR) auszuweiten, um deren Relevanz und die Wertigkeit der Infrarot-Pupillographie für eine mögliche Implementierung in polizeiliche Routineverkehrskontrollen demonstrieren zu können. Material und Methoden: Die Iris gesunder Probanden (n = 41) sowie von Personen, die unter dem Einfluss zentral-nervös wirksamer Substanzen standen (n = 105), wurden unter Verwendung von Infrarottechnologie unterschiedlichen Lichtreizen ausgesetzt. Nach entsprechender Messung und Aufsplitten des PLR in Einzelparameter erfolgte die statistische Auswertung. Ergebnisse: Der PLR zeigt sich bei Personen, die unter der Wirkung zentral-nervös wirksamer Substanzen stehen, als signifikant verändert. In Übereinstimmung mit vorpublizierten Daten konnte bei der Mehrheit der Parameter die hohe Wertigkeit des PLR als verlässlicher Indikator für einen vorangegangenen Konsum von Drogen und/oder zentral-nervös wirksame Medikamente nachgewiesen werden. Die dafür aussagekräftigsten Parameter werden in der vorliegenden Studie präsentiert. Diskussion: Infrarot-Pupillographie repräsentiert eine objektive Untersuchungsmethode der Pupillenfunktion, die es ermöglicht, Hinweise auf eine mögliche Beeinflussung durch zentral-nervös wirksame Substanzen zu liefern. Die vorliegende Studie belegt die Anwendbarkeit des verwendeten Messinstrumentes für den mobilen Einsatz im Rahmen polizeilicher Routineverkehrskontrollen, so dass unseres Erachtens die Infrarot-Pupillographie künftig als ständige Methode in geplanten Polizeikontrollen, vorzugsweise in Zusammenarbeit mit rechts- bzw. verkehrsmedizinischen Zentren, zum Einsatz kommen sollte. Background: In order to evaluate driving abilities of each traffic participant, standardized and objective measurement methods are still needed. The applicability and value of infrared pupillography as an objective measurement method to indicate possible influence of central nervous acting substances has been demonstrated in former publications. Objectives: To tie in with first results of the study, the aim was to extend the statistical analysis to further parameters of the pupillary light reflex (PLR) in order to demonstrate their relevance and to substantiate the value of infrared pupillography for possible implementation in the framework of routine police traffic checks. Materials and methods: We exposed the iris of healthy test subjects (n = 41), as well as of persons who were under the influence of drugs and/or medication (n = 105), to different light stimuli using infrared technology. After measuring and splitting the PLR into single parameters a statistical analysis was performed. Results: The pupillary light reflex was significantly alterated when the examined person was under the influence of central nervous acting substances. In concordance with former reported results, the majority of the parameters approved the high value of the PLR as a reliable indicator of previous consumption of drugs and/or central nervous acting medication. The most appropriate parameters of the pupillary light reflex for identification of drivers under the influence of central nervous acting substances are indicated in the study. Conclusions: Infrared pupillography represents an objective method of measuring the pupil function to indicate a possible influence by central nervous acting substances. As we were able to prove the applicability of the device used in the present study during routine police traffic controls, we suggest that infrared pupillography should become a regular method in scheduled traffic controls in the future, preferably in cooperation with forensic medical centers. F.C. Monticelli, W. Hitzl, F. Priemer, U. Preiss, S.N. Kunz, T. Keller

In geriatrics, driving cessation is addressed within the biopsychosocial model. This has broadened the scope of practitioners, not only in terms of assessing fitness to drive, but also by helping to maintain social engagements and provide support for transport transition. Causes can be addressed at different levels by adapting medication, improving physical health, modifying behaviour, adapting lifestyle, or bringing changes to the environment. This transdisciplinary approach requires an understanding of how different disciplines are linked to each other. This article reviews the philosophical principles of causality between fields and provides a framework for understanding causality within the biopsychosocial model. Understanding interlevel constraints should help practitioners overcome their differences, and favor transversal approaches to driving cessation.

Hintergrund: Um die Fahrtüchtigkeit eines Teilnehmers am Straßenverkehr zu evaluieren, sind objektive und standardisierte Messmethoden notwendig. In rezenten Studien konnte nachgewiesen werden, dass die Pupillenfunktion als signifikanter Indikator zur Beurteilung des Einflusses durch zentral-nervös wirksame Substanzen herangezogen werden kann. Ziel der Arbeit: Ziel dieser Studie ist die Beantwortung der naheliegenden Frage: „Ist es basierend auf der Pupillenfunktion möglich zu ermitteln, ob eine bestimmte Person unter der Wirkung von Drogen oder Medikamenten steht oder nicht?“ Material und Methoden: Insgesamt wurden 121 Probanden einer infrarot-pupillographischen Untersuchung des Auges unter Verwendung unterschiedlicher Lichtreize unterzogen. Dabei wurden einerseits 41 gesunde, nicht beeinträchtigte, andererseits 80 Probanden untersucht, welche nachweislich unter dem Einfluss von Drogen oder Medikamenten standen. Neuronale Netze mit unterschiedlicher Netzwerkarchitektur wurden in einer Lerngruppe trainiert, danach in einer Verifikationsstichprobe weiter analysiert und in einer unabhängigen Teststichprobe abschließend getestet. Spezifität, Sensitivität, der negative und positive prädiktive Wert als auch der prozentuale Anteil der insgesamt als korrekt eingestuften Probanden wurden ermittelt. Für sämtliche Performancewerte wurden 95 %-Konfidenzintervalle (CI) angegeben. Ergebnisse: Ein neuronales Netzwerk mit folgenden Werten konnte ermittelt werden: Spezifität (91 %, 95% CI 7898 %), Sensitivität (90 %, 95 % CI 8196 %), negativer prädiktiver Wert (85 %, 95 % CI 7294 %) und positiver prädiktiver Wert (94 %, 95 % CI 8698 %); 90 % (95 % CI 8395 %) aller Personen wurden korrekt eingeschätzt. Schlussfolgerung: Die Ergebnisse dieser Studie zeigen eindeutig, dass es mittels Infrarot-Pupillographie zumindest in diesem speziellen Studiensetting möglich ist, Personen, die unter dem Einfluss von Drogen oder Medikamente stehen, klar zu identifizieren. Background: In order to evaluate the ability of traffic participants to drive, standardized and objective measurement methods are needed. In recent analyses it was shown that pupil function is a significant indicator of being under the influence of substances acting on the central nervous system. Objective: The aim of this study was to answer the question whether it is possible to detect if a person is under the influence of drugs or medication based on pupil function. Material and methods: In total 121 subjects were exposed to different light stimuli and an infrared pupillographic investigation of the eyes was carried out. The study cohort consisted of 41 healthy test subjects and 80 subjects under the influence of drugs or medication. Several neural network models with different network architectures were trained in a learning group, further analyzed in a verification sample and most importantly tested in an independent test sample. Specificity, sensitivity, negative and positive predictive values as well as the percentage of correctly predicted subjects were analyzed. A 95% confidence interval (CI) was included for all performance measurements. Results: A neural network model was found which performed with a specificity of 91% (95% CI, 7898%), sensitivity 90% (95% CI, 8196%), negative predictive value 85% (95% CI, 7294%), positive predictive value 94% (95% CI, 8698%) and a correct prediction was made for 90% (95% CI, 8395%) of the subjects. Conclusion: The results of this study clearly show that infrared pupillography provides excellent discrimination between healthy subjects and persons under the influence of drugs or medication in this specific setting. W. Hitzl, T. Keller, F. Monticelli

U radu su prikazani rezultati ocjenjivanja zdravstvene sposobnosti u odnosu prema alkoholizmu u vozača profesionalaca i kandidata za vozače profesionalne obavljenog u Djelatnosti medicine rada Doma zdravlja u Rijeci u razdoblju od 1991. do kraja prve polovice 1995. godine. Od ukupno 6.695 u 354 utvrđena je nesposobnost za upravljanje motornim vozilima. Od 66 profesionalnih vozača i kandidata za vozače profesionalne koji su ocijenjeni nesposobnima zbog ovisnosti o alkoholu (što je 19% nesposobnih, odnosno 1% pregledanih), u 18 ih je u dva i vise navrata došlo do recidiva pošto im je vraćena vozačka dozvola nakon kontrolirane apstinencije od šest i više mjeseci te im je dozvola ponovno oduzeta. To upućuje na zaključak da je 27% vozača profesionalaca i kandidata za vozače profesionalce s učestalim recidivom u okviru skupine onesposobljenih zbog alkoholizma, visok postotak. Stoga se predlaže izmjena Pravilnika o utvrđivanju zdravstvene sposobnosti za upravljanje vozilima na motorni pogon, u smislu donošenja ocjene o trajnoj nesposobnosti za upravljanje motornim vozilima nakon višekratnih recidiva ili privremenoj nesposobnosti tijekom dužeg razdoblja nakon prvog recidiva u ovisnika o alkoholu., In the Occupational Medicine Unit of the Primary Health Centre in Rijeka health ability of 6695 professional drivers and applicants for professional driving licence was assessed in respect to alcohol abuse over the period from 1991 until mid-1995. A total of 354 drivers were found to be unfit for driving a motor vehicle. Among them 66 drivers (19% of the unfit and 1 % of all examined drivers) were found to be unfit because of alcoholism. Eighteen of those, all with a controlled period of abstinence of at least six months, after return of the driving licence, were reported to have two or more recurrences of alcohol abuse, and had their driving licence laken away again. Results suggest that the percentage (27%) of drivers who as multiple recidivists wete declared unfit for driving is high considering the total number of drivers declared unlit lor driving because of alcoholism. Therefore a change is proposed to be made in the Book of Rules for the Assessment of Health Ability for Motor Vehicles Driving, calling for assessment of permanent disability for driving after multiple alcohol dependence recidivism or for temporary disability for driving during an extended period after the first established relapse of alcohol dependence.