Crash and injury reduction following installation of roundabouts in the United States.
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OBJECTIVES: This study estimated potential reductions in motor vehicle crashes and injuries associated with the use of roundabouts as an alternative to signal and stop sign control at intersections in the United States. METHODS: An empiric Bayes procedure was used to estimate changes in motor vehicle crashes following conversion of 24 intersections from stop sign and traffic signal control to modern roundabouts. RESULTS: There were highly significant reductions of 38% for all crash severities combined and of 76% for all injury crashes. Reductions in the numbers of fatal and incapacitating injury crashes were estimated at about 90%. CONCLUSIONS: Results are consistent with numerous international studies and suggest that roundabout installation should be strongly promoted as an effective safety treatment. (+info)
Extending the boundaries of the Declaration of Helsinki: a case study of an unethical experiment in a non-medical setting.
(66/1390)
To examine the ethical issues involved in governmental decisions with potential health risks, we review the history of the decision to raise the interurban speed limit in Israel in light of its impact on road death and injury. In 1993, the Israeli Ministry of Transportation initiated an "experiment" to raise the interurban speed limit from 90 to 100 kph. The "experiment" did not include a protocol and did not specify cut-off points for early termination in the case of adverse results. After the raise in the speed limit, the death toll on interurban roads rose as a result of a sudden increase in speeds and case fatality rates. The committee's decision is a case study in unfettered human experimentation and public health risks when the setting is non-medical and lacks a defined ethical framework. The case study states the case for extending Helsinki type safeguards to experimentation in non-medical settings. (+info)
A technology to measure multiple driving behaviors without self-report or participant reactivity.
(67/1390)
An in-vehicle information system (IVIS) was used to videotape drivers (N = 61) without their knowledge while driving 22 miles in normal traffic. The drivers were told that they were participating in a study of direction following and map reading. Two data-coding procedures were used to analyze videotapes. Safety-related behaviors were counted during consecutive 15-s intervals of a driving trial, and the occurrence of certain safety-related behaviors was assessed under critical conditions. These two methods of data coding were assessed for practicality, reliability, and sensitivity. Interobserver agreement for the five different driving behaviors ranged from 85% to 95%. Within-subject variability in safe driving was more pronounced among younger drivers and decreased as a function of age. Contrary to previous research that has relied on self-reports, driver risk taking did not vary significantly as a function of gender. These results are used to illustrate the capabilities of the technology introduced here to design and evaluate behavior-analytic interventions to increase safe driving. (+info)
Application of the induced exposure method to compare risks of traffic crashes among different types of drivers under different environmental conditions.
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The authors used the induced exposure method to compare risks of traffic crashes among different types of Spanish drivers under different environmental conditions. The authors analyzed traffic crashes recorded by the Spanish Direccion General de Trafico for the years 1991 and 1992 to compare proportions of drivers in different age/sex categories who were involved in single-vehicle and multivehicle crashes under different psychological and physical conditions. Crash risk was 1.42- to 2.35-fold greater in men than in women, depending on driver category and environmental factors. Risk was also significantly higher in the 18- to 24-year-old age group (1.75- to 2.87-fold greater than in drivers aged 25-49 years) and under abnormal psychological-physical conditions (1.69- to 4.10-fold greater among drivers under the influence of alcohol). Twilight and night driving, driving in urban areas, and driving on weekends and legal holidays were also associated, though nonsignificantly, with a slightly higher traffic crash risk. These findings are consistent with earlier reports, and they support the usefulness of the induced exposure method as an easy and economical tool with which to analyze data contained in traffic crash records. (+info)
Lowered legal blood alcohol limits for young drivers: effects on drinking, driving, and driving-after-drinking behaviors in 30 states.
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OBJECTIVES: This study evaluated the effects on drinking and driving of lowered allowable blood alcohol concentration (BAC) limits for drivers younger than 21 years in 30 US states between 1984 and 1998. METHODS: Outcome measures were based on self-reports from a cross-sectional sample of more than 5000 high school seniors in 30 states surveyed before and after BAC limits were implemented in their states. RESULTS: Frequency of driving after any drinking and driving after 5 or more drinks declined 19% and 23%, respectively. Lower BAC limits did not affect overall amount of drinking or total number of miles driven. CONCLUSIONS: Significant beneficial effects of lowered youth BAC limits have appeared despite limited publicity and enforcement of the new laws. (+info)
Alcohol-related problems and fitness to drive.
(70/1390)
This paper analyses the alcohol consumption patterns in Spanish drivers, the incidence of alcohol-related problems and attempts to ascertain whether, in the end, drivers with alcohol-related problems are considered fit or unfit to drive. In accordance with Spanish and European Union legislation, driving licences cannot be issued or renewed to people suffering from alcohol-related problems. A medical, psychological and eyesight evaluation was performed to test the driving fitness of 8043 drivers attending 25 Medical Driving Test Centres on a national scale. Among other things, information was collected on the patterns of alcohol consumption, the AUDIT and CAGE tests, the incidence of alcohol-related problems (DSM-IV criteria for abuse, dependence and alcohol-induced disorder), as well as an evaluation of their fitness to drive. In all, 60.3% of drivers drink alcohol on a regular basis; 7.3% of drivers scored > or = 8 points in the AUDIT test, and 2% met criteria for DSM-IV alcohol abuse, dependence or induced disorder. Drivers with alcohol-related problems have been involved in traffic accidents (23.2%) and have infringed driving regulations (18.7%) more frequently (P < 0.0001) than those without alcohol-related problems. Of those with alcohol-related problems, 72.2% were considered fit to drive. The study reveals that alcohol consumption is common among drivers, that a significant number of drivers have alcohol-related problems, and that three in four of the latter were considered fit to drive. (+info)
Return to driving after head injury.
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OBJECTIVES: To determine whether patients who return to driving after head injury can be considered safe to do so and to compare the patient characteristics of those who return to driving with those who do not. METHODS: In a multicentre qualitative study 10 rehabilitation units collectively registered 563 adults with traumatic brain injury during a 2.5 year period. Recruitment to the study varied from immediately after hospital admission to several years after injury. Patients and their families were interviewed around 3 to 6 months after recruitment. A total of 383 (67.5%) subjects were interviewed within 1 year of injury, of whom 270 (47.6%) were interviewed within 6 months of injury. Main outcome measures were the presence or absence of driving related problems reported by drivers and ex-drivers, and scores on driving related items of the functional independence/functional assessment measure (FIM+FAM). RESULTS: Of the 563 patients 381 were drivers before the injury and 139 had returned to driving at interview. Many current drivers reported problems with behaviour (anger, aggression, irritability; 67 (48.2%)), memory ( 89 (64%)), concentration and attention (39 (28.1%)), and vision (39 (28.1%)). Drivers reported most driving related problems as often as ex-drivers, main exceptions were epilepsy and community mobility. Current drivers scored significantly higher on the FIM+FAM (were more independent), than ex-drivers. The driving group had sustained less severe head injuries than ex-drivers; nevertheless, 78 (56.2%) current drivers had received a severe head injury. Few (61 (16%)) previous drivers reported receiving formal advice about driving after injury. CONCLUSIONS: The existence of problems which could significantly affect driving does not prevent patients returning to driving after traumatic brain injury. Patients should be assessed for both mental and physical status before returning to driving after a head injury, and systems put in place to enable clear and consistent advice to be given to patients about driving. (+info)
Recurrence of symptomatic ventricular arrhythmias in patients with implantable cardioverter defibrillator after the first device therapy: implications for antiarrhythmic therapy and driving restrictions. CARE Group.
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OBJECTIVES: The purpose of this study was to investigate whether clinical or electrophysiologic characteristics could predict initial and subsequent implantable cardioverter defibrillator (ICD) therapy. BACKGROUND: Identification of markers to predict subsequent ICD therapy and symptoms after the first event could affect patient management. METHODS: We analyzed baseline and follow-up data on 125 ICD patients followed for 408+/-321 days. Medications and ICD programming were not changed after first ICD therapy. RESULTS: Implantable cardioverter defibrillator therapy occurred in 58 patients (46%). Clinical features were as follows: mean left ventricular ejection fraction (LVEF) 29%+/-15%; coronary artery disease 84%; presenting arrhythmia with sustained monomorphic ventricular tachycardia (SMVT) in 68%. In a multivariate analysis the relative risk for ICD therapy in patients presenting with SMVT versus cardiac arrest (CA) was 2.57 (range, 1.32 to 5.01), and for patients with LVEF < or =25%, 1.95 (1.11 to 3.45), respectively (p < 0.05). Implantable cardioverter defibrillator therapy was not predicted by any other variable. Forty-six patients had second ICD therapy. Mean time to second ICD therapy was only 66+/-93 days compared with 138+/-168 days for first ICD therapy (p < 0.05). No predictor for second ICD therapy was found. Regarding symptoms, impaired consciousness during initial ICD therapy was predicted only by SMVT cycle length <250 ms at electrophysiologic testing. In contrast, symptoms were similar between first and second ICD therapy (p = 0.0001). Of note, ventricular tachycardia cycle length preceding first and second ICD therapy was similar (r = 0.76, p = 0.001). CONCLUSIONS: First ICD therapy tends to occur in patients presenting with SMVT and LVEF < or =25%. Subsequent therapy occurs sooner and is unpredictable, suggesting that antiarrhythmic drug therapy should be considered after the first symptomatic ICD therapy. Symptoms during first ICD therapy predict subsequent symptoms, and patients presenting with SMVT and asymptomatic first ICD therapy are at very low risk for future syncopal ICD therapy. (+info)