BACKGROUND: Only prospective cohort studies can capture changes in work conditions and their effects on health. Such studies are rare in bus drivers, despite their high rates of injuries and diseases. The three existing cohorts have limited exposure data, collected at baseline and thus uninformative on exposure and exposure-effect dynamics. Therefore, we aimed to develop the Swiss Transport Personnel Health Cohort (TRAPHEAC) and to anticipate and prevent potential bias. METHODS: To set up the study protocol, we first organized the stakeholder consultation and available data inventory. Second, we mapped the exposure-outcomes pairs to list the most prevalent occupational hazards, and conducted exposure measurement campaigns. Third, we built the Swiss Bus-Exposure Matrix for physical-chemical hazards and Bus-Ergonomics Matrix for visual and biomechanical constrains. These matrices contain 705 bus models operated in Switzerland since 1980 and enable assessing current and past exposure when merged with bus drivers' work histories. RESULTS: We opted for an original study design combining prospective cohort part starting at 2024 and a retrospective part with nested case-control studies. Bus drivers will be invited through three complementary channels: unions, companies, and social media. The eligibility screening, information, and consent form signature and registration will be conducted using the study web-site modules. Registered bus drivers will first receive a comprehensive inclusion questionnaire, then a yearly follow-up questionnaire to assess and update the drivers' work histories. Validated self-reported questionnaires will be used for assessing additional health outcomes (e.g., stress, sleep problems, musculoskeletal disorders, burnout) and individual, occupational and live-style related factors (e.g., personality, ICT use, physical activity). Hospital records (with diagnosed diseases, diagnosis dates and treatments) centralized since 2000 by the Swiss Federal Statics Office will be used for assessing disease prevalence, incidence and case-control status. Advanced statistical analysis will be conducted to address etiological and methodological questions (e.g., individual and joint causal effects of multiple exposures and exposure components; time-varying exposure and outcome variables and confounders mixtures). CONCLUSIONS The yearly assessment of both exposure and health outcomes should enable capturing changes in work conditions and their effects on bus drivers' health and well-being over time and facilitate the tailoring, implementation and evaluation of preventive interventions.
Humans ; Switzerland/epidemiology* ; Prospective Studies ; Occupational Exposure/statistics & numerical data* ; Occupational Diseases/epidemiology* ; Cohort Studies ; Motor Vehicles ; Research Design ; Retrospective Studies ; Case-Control Studies ; Occupational Health ; Adult ; Male ; Female

BACKGROUND: Technological innovations in the public transport sector are increasingly leveraged to support the goals of environmental sustainability and public health. Eco-driving assistance (EDA) systems represent one such intervention, aimed at reducing fuel consumption, emissions, and operating costs while improving passenger comfort. However, the potential unintended impacts of EDA technologies on driver health and well-being remain understudied. The EDA Trial, part of the EU-funded INTERCAMBIO project, seeks to evaluate whether the use of EDA systems may introduce new psychosocial stressors for professional drivers, with implications for occupational and public health. METHODS: The EDA tested in this trial is called "NAVIG". Buses will be assigned randomly. Operating EDA-equipped vehicle will be considered as intervention condition, operating vehicle without EDA as control. Each participant will be monitored for 10 working days maximum to accumulate at least 5 intervention shifts during the trial. Heart rate variability (HRV) will be continuously recorded during working hours to assess autonomous stress responses. The root mean square of successive differences (RMSSD) will be averaged over intervention and control shifts to enable within-subject comparisons between intervention and control conditions. Subjective stress levels will be evaluated using the self-report instruments: Cohen's perceived stress scale at baseline and visual analogous scale at baseline and daily. Moreover, neuroendocrine stress biomarkers (salivary cortisol and cortisone) will be collected repeatedly across shifts, as additional outcomes. Mixed-effects models with participant's ID as a random effect variable will be used to compare stress outcomes between EDA and non-EDA driving conditions. Models will be adjusted for potential confounders. RESULTS: A sample size of 26-40 participants was estimated to provide 80% power (α = 0.05) to detect differences of 12-15% between conditions. Ethical approval was obtained from the Swissethics (CER-VD 2024-01573), and participant recruitment is ongoing, with 27 drivers enrolled as of June 2025. CONCLUSIONS: This study will provide empirical evidence on the potential health trade-offs associated with implementing eco-driving technologies in real-world settings. By assessing physiological and psychological stress responses to EDA, the trial supports a more integrated approach to environmental technology evaluation-one that considers not only energy efficiency but also the health and sustainability of the workforce. TRIAL REGISTRATION The trial was registered in the ClinicalTrials.gov database (NCT06688721).
Humans ; Automobile Driving/psychology* ; Stress, Psychological ; Motor Vehicles ; Adult ; Male ; Randomized Controlled Trials as Topic ; Female

The wound mechanism, injury characteristics and treatment principles of anti-armored vehicle ammunition against armored crew in the past 20 years are summarized in this paper. Shock vibration, metal jet, depleted uranium aerosol and post armor breaking effect are the main factors for wounding armored crew. Their prominent characteristics are severe injury, high incidence of bone fracture, high rate of depleted uranium injury, and high incidence of multiple/combined injuries. During the treatment, attention must be paid on that the space of armored vehicle is limited, and the casualties should be moved outside of the cabin for comprehensive treatment. Especially, the management of depleted uranium injury and burn/inhalation injury are more important than other injuries for the armored wounds.
Humans ; Uranium/analysis* ; Respiratory Aerosols and Droplets ; Motor Vehicles ; Burns/therapy* ; Multiple Trauma

Objective: To analyze the mortality level and tendency of road traffic injury in Shandong province from 2012 to 2020. Methods: Based on the data of road traffic deaths from the cause of death registration system in Shandong province from 2012 to 2020, the mortality rates of road traffic injury were calculated by sex, age, area, and injury type. The mortality was standardized based on the age structure of the Chinese population in the sixth Population Census in 2010. The annual percent change (APC) and average annual percent change (AAPC) of the mortalities and the standarized mortalities were calculated by using Joinpoint regression model, and the trends were also examined. Results: In 2020, the crude mortality of road traffic injury in Shandong Province was 15.58/100 000, and the standardized mortality was 12.90/100 000. From 2012 to 2020, the standardized mortality of road traffic injury in Shandong province showed a downward trend with AAPC of -5.4%. The standardized mortality of middle-south mountain areas, male and children aged 0-14 years in Shandong showed a significantly decreasing trend with AAPC of -6.8%, -6.1% and -6.0%, respectively. The standardized mortality of people aged 65 years and over did not decrease significantly, but the number of deaths increased significantly by 50.96% in 2020 (5 780 cases), compared with those in 2012 (3 829 cases). The standardized mortality of pedestrian and motorcyclists decreased significantly with AAPC of -7.5% and -6.7%, respectively. There was no significant change in the standardized mortality among people who rode motor vehicles or bicycles. Conclusion: From 2012 to 2020, the standardized mortality of road traffic injury in Shandong Province showed an obvious downward trend, but the standardized mortality of people aged 65 years and over did not decrease significantly. In the future, it is still necessary to take government-led, multi-sectoral collaboration, with a focus on comprehensive preventive measures, to further reduce road traffic injury mortality.
Accidents, Traffic ; Asian People ; Child ; Government ; Humans ; Male ; Mortality ; Motor Vehicles

Introduction: Road traffic accidents are a growing public health burden, especially in the low- and middle-income countries (LMICs). With resource scarcity, road traffic injuries may lead to poor quality of life among survivors, or deaths at worst. Victims of crashes involving transportations are gendered; therefore, there may be differences in the trends and characteristics of injuries sustained by men and women related to road crash. Objectives: This study aimed to determine the factors related to severity of road crashes among women road users in the Philippines from 2008 to 2017. Methods: We conducted a retrospective review of clinical records of women patients involved in road crash at the Trauma Division, Department of Surgery of the Philippine General Hospital (PGH) for the ten-year period, January 1, 2008 to December 31, 2017. Data were extracted from the electronic patient records in Integrated Surgical Information System (ISIS). Results: From 2008 to 2017, 926 of the road crash victims brought to PGH were women. There was an increasing trend, with the years 2015 to 2017 accounting for half of the total cases (55.62%). The highest cases of women patient admissions were also recorded during the months of June and July (5.61%). The CALABARZON region (11.23%) and National Capital Region (8.21%) had the highest admissions. The patients were most commonly pedestrians (12.20%) and involved in collisions (13.50%) or vehicle involvement (13.17%). The most common vehicle involved was a motorcycle (9.72%) followed by car and vans (1.62%). Only a small proportion of women patients used helmets (3.33%) and seatbelts (0.12%). The median length of hospital stay of women patients was 5 days. The most commonly sustained injuries among patients were multiple (83.65%), external (43.72%), extremity (33.15%), head and neck (23.47%), and face (21.58%) injuries. Among these, injuries to the extremity had the highest average length of hospital stay (16.04 ± 31.28 days) while external and head and neck injuries had the shortest (10.81 ± 33.42 days). Multinomial regression showed that women patients who suffered from head and neck, and abdominal injuries had increased odds of dying by 4.94 times (CI: 2.158-11.302, p < 0.05), and 3.33 times (CI:1.235-9.02, p < 0.05), respectively, compared to those who did not suffer said injuries. Conclusion There is a significant number of women involved in road crashes in the Philippines, and therefore, there is a need for directed policies on female road users as vulnerable road users.
Accidents ; Women ; Motor Vehicles ; Length of Stay ; Hospitalization

Isolated posterolateral corner (PLC) injury associated with a Schatzker type 2 fracture is a very rare combination of injuries. A male who was driving a motor vehicle was injured after a collision accident. The plain radiographs and computed tomography scans of the knee showed a Schatzker type 2 fracture of the tibial plateau, mostly in the anterolateral portion of tibial plateau, and an avulsion fragment on the fibular tip. Magnetic resonance imaging showed no injury to cruciate ligaments, medial collateral ligament, or any meniscal injury. We performed an open reduction operation and internal fixation for treating the fracture. Six months later, he complained of instability. At 11 months later after initial operation, we performed the second operation for stabilizing the PLC. We present here a rare case of an isolated PLC injury associated with a Schatzker type 2 fracture. We discuss the mechanism of injury and review similar cases.
Collateral Ligaments ; Humans ; Knee ; Ligaments ; Magnetic Resonance Imaging ; Male ; Motor Vehicles ; Tibial Fractures

PURPOSE: Adrenal gland injuries in trauma are rare and usually misdiagnosed or underestimated in an emergency setting because they are asymptomatic and associated with severe abdominal injuries. This paper reviews the clinical characteristics of adrenal injuries. METHODS: A retrospective analysis of trauma patients who visited the authors' emergency center was performed from March, 2010 to December, 2017. The patient demographic data, injury mechanism & associated injuries, injury severity score, hospital stay, and mortality were retrieved and analyzed. RESULTS: Adrenal gland injuries were found in 52 patients: 73.1% (n=38) were males and the mean age was 43.6 years. Of the patients, 84.6% (n=44) had ISS ≥15. Right adrenal gland injuries occurred in 82.7% (n=43). The mechanism of injury was falls in 30.8% (n=16), motor vehicle accidents in 25.0% (n=13), and pedestrian accidents in 23.1% (n=12). Associated injures were liver injury (58.5%), rib fracture (52.8%), kidney injury (24.5%), pelvic bone fracture (20.8%), spine fracture (28.3%), and spleen injury (13.2%). The mean hospital stay was 34.2 days, and the intensive care unit stay was 9 days. The mortality rate was 3.8% (n=2). CONCLUSION: Adrenal gland injuries are common in males and frequent in the right side. Falls are the leading cause of injury. Most injuries have an associated injury at the abdominal or thoracic region. Adrenal injury is accompanied by high injury severity but showed a good prognosis.
Abdominal Injuries ; Accidental Falls ; Adrenal Glands ; Emergencies ; Humans ; Injury Severity Score ; Intensive Care Units ; Kidney ; Length of Stay ; Liver ; Male ; Mortality ; Motor Vehicles ; Pelvic Bones ; Prognosis ; Retrospective Studies ; Rib Fractures ; Spine ; Spleen

STUDY DESIGN: Case report. OBJECTIVES: To document the first known case of posterior migration of a herniated disc in a lumbar flexion-distraction injury. SUMMARY OF LITERATURE REVIEW: Lumbar disc herniation is sometimes confused with epidural hematoma, especially when the disc migrates posterior to the thecal sac. There has been no report of posterior migration of a herniated disc after a lumbar flexion-distraction injury. MATERIALS AND METHODS: A 47-year-old woman with no pertinent medical history was diagnosed with a flexion-distraction injury of the L2–L3 vertebrae after a motor vehicle accident. The patient had no neurological deficit initially. Magnetic resonance imaging (MRI) showed a space-occupying lesion with T2 hyperintensity and T1 isointensity on the dorsal side of the thecal sac at L2–L3. After posterior lumbar fixation and fusion, progressive leg weakness occurred 1 week postoperatively. RESULTS: A second operation revealed no evidence of epidural hematoma, but a sequestrated disc. Decompression and sequestrectomy were performed, and the patient's neurological status had recovered fully at 4 months postoperatively. CONCLUSIONS: This case highlights the potential for posterior migration of a herniated disc with flexion-distraction injuries of the thoracolumbar spine. Discontinuity of the posterior annulus fibrosus on MRI may aid the distinction of posterior migration of a herniated disc from epidural hematoma. Because posterior migration of a herniated disc is associated with progressive neurological deficits, surgeons must consider decompression surgery when such herniation is suspected, even in the absence of neurological symptoms.
Decompression ; Female ; Hematoma ; Humans ; Intervertebral Disc Displacement ; Leg ; Magnetic Resonance Imaging ; Middle Aged ; Motor Vehicles ; Spine ; Surgeons

PURPOSE: This study aimed to identify the level of health problems and the factors that affect health problems for concrete mixer truck divers. METHODS: The questionnaires were administered to 111 drivers in 6 Remicon workplaces located in D city and 7 Remicon workplaces located in K city from September 10 to 28, 2018. A total of 111 questionnaires were collected and 106 were used, excluding 5 incomplete ones. Data were analyzed with frequency, percentage, χ2 test, multiple logistic regression analysis by SPSS/WIN 23.0. RESULTS: The factors affecting subjective health were eating habits, sleeping hours and drinking conditions. The factors that affected chronic diseases were age, eating habits, sleep hours, and drinking conditions. The factors influencing musculoskeletal complaints were work experience, eating habits, and sleep hours. CONCLUSION: The major influencing factors of health problems were eating habits, sleeping hours. This study suggests that it is necessary to run a systematic health care program for the desirable health behaviors in the communities and industrial fields.
Chronic Disease ; Delivery of Health Care ; Diagnostic Self Evaluation ; Drinking ; Eating ; Health Behavior ; Health Status ; Logistic Models ; Motor Vehicles ; Musculoskeletal Diseases

OBJECTIVES: Young athletes require adequate nutrition to maintain their athletic performance, growth and health. This study examined the status and needs of nutrition management and meal services for student athletes among the athlete's parents. METHODS: The subjects were parents of elementary, middle, and high school athletes (n=323) from 18 schools participating mainly in the Sports Food Truck. The questionnaire included general characteristics, status and needs on nutrition management and meal service for student athletes, and satisfaction with the Food Truck. The survey was done during 2018. The data were analyzed according to the school groups using a χ2-test or ANOVA. RESULTS: Approximately 45% of subjects had difficulty in the nutrition management of athletes, and 87.1% had not received nutrition education. Approximately 74% wanted nutrition education held for athletes, and mainly wanted topics on nutrition management for health and eating for athletic performance. The preferred methods were lectures and cooking activity. The responses on the necessity of nutrition education for athletes, desired education topics, and desired times for education differed significantly according to the school groups (p < 0.05). Most subjects also wanted nutrition information mainly through SNS. In the athlete's meal, breakfast and snacks were highlighted as the meal to supplement. Approximately 90.3% responded that providing a meal service is necessary. The subjects preferred snacks before/after exercise and dinner if a meal service was provided. They preferred Korean food, followed by snacks, and a dish meal. As the meal type, the subjects wanted the Food Truck and packed meal. The responses on necessity of a meal service (p < 0.05), preferred food (p < 0.001), and meal type (p < 0.001) in the meal service differed significantly according to the school groups. Approximately 43% were satisfied with the Food Truck and 50.8% responded as average. They made suggestions for the Food Truck in terms of foods, operations and frequency. CONCLUSIONS: Based on the study results, nutrition education and meal service may support nutrition for student athletes considering the needs of the parents according to the school groups.
Athletes ; Athletic Performance ; Breakfast ; Cooking ; Eating ; Education ; Humans ; Lectures ; Meals ; Motor Vehicles ; Needs Assessment ; Parents ; Snacks ; Sports