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

Objective: To compare the proportion of temporal bone fractures using traditional (longitudinal vs. transverse) and otic involvement (otic sparing vs. non-otic sparing) classification schemes and their relationship with the development of facial paralysis. Methods: Design: Retrospective Case Series. Setting: Tertiary Government Hospital. Participants: Records of 49 patients diagnosed with temporal bone fracture in our institution from August 2016 to June 2018. Results: A total of 41 records of patients with temporal bone fractures, 32 males, 9 females, aged 5 to 70 years-old (mean 37.5-years-old) were included. In terms of laterality 23 (56%) involved the right and 17 (41%) the left side. Traditionally classified, 32 (78%) were longitudinal and 9 (22%) were transverse. Using newer classification based on otic involvement and non-otic involvement, 38 (93%) were otic-sparing and 3 (7%) were non otic-sparing. Only 9 (22%) out of 41 total fracture patients developed facial paralysis, involving 7 of the 32 longitudinal fractures and 2 of the 9 transverse fractures, or 8 of the 38 otic-sparing and 1 out of 3 non otic-sparing fractures. Conclusion Because of the small sample size, no conclusions regarding the proportion of temporal bone fractures using traditional (longitudinal vs. transverse) and otic involvement (otic sparing vs. non-otic sparing) classification schemes and their relationship with the development of facial paralysis can be drawn in this study.
Human ; Male ; Female ; Aged (a Person 65 Through 79 Years Of Age) ; Middle Aged (a Person 45-64 Years Of Age) ; Craniocerebral Trauma ; Motor Vehicles ; Accident Traffict ; Facial Paralysis

BACKGROUND AND OBJECTIVES: Obstructive sleep apnea (OSA) is highly prevalent in commercial vehicle operators (CMVOs). This study aimed to evaluate the poor sleep quality, daytime sleepiness, and the prevalence of self-reported OSA in CMVOs. SUBJECTS AND METHOD: We performed a retrospective review of the medical records of patients who visited a single institution with sleep problems from 2011 January to 2016 December. Among the patients, a total of 38 CMVOs was analyzed. Clinical information, questionnaires about sleep quality (Pittsburg sleep questionnaire, PSQI), excessive daytime sleepiness (Epworth sleepiness scale, ESS) and risk factors for OSA (STOP-Bang) were analyzed. The frequency of motor vehicle accidents and near accidents was assessed, and polysomnography (PSG) was used for OSA diagnosis purposes. RESULTS: The mean age of the study population was 45.3±11.8 years. The average score of PSQI, ESS, and STOP-Bang were 6.75±4.22, 10.79±7.12, and 4.62±3.34, respectively. A significant association between near accidents and high-risk group of OSA was observed [odds ratio (OR)=2.73, 95% confidence interval (CI)=1.08–4.48]. Subjects with poor sleep quality showed significantly increased risk of near accidents (OR=2.34, 95% CI=1.01–3.56). Receiver operating characteristic curves of STOP-Bang questionnaire using apnea-hypopnea index (cut-off value=5) indicates that suspected OSA group predicted by STOP-Bang score was significantly correlated with OSA severity (area under curve=0.72, sensitivity 77.1%, specificity 59.4%). CONCLUSION: Administration of STOP-Bang questionnaire before a PSG can identify high-risk subjects, supporting its further use in OSA screening of CMVOs.
Diagnosis ; Humans ; Korea ; Mass Screening ; Medical Records ; Methods ; Motor Vehicles ; Polysomnography ; Prevalence ; Retrospective Studies ; Risk Factors ; ROC Curve ; Sensitivity and Specificity ; Sleep Apnea, Obstructive ; Surveys and Questionnaires

PURPOSE: Vehicle-pedestrian conflicts are common at road intersections when traffic lights change. However, the impact of traffic light on transportation safety and efficiency remains poorly understood. METHODS: A two-stage study was used to survey the proportion of intersections with conflicting traffic lights and the related transportation efficiency and safety were evaluated as well. First, a cross-sectional study estimated the proportion of signalized intersections with conflicting left-turning vehicle-pedestrian traffic lights in Changsha city, China. Second, a natural experiment compared transportation efficiency and safety between intersections with and without conflicting left-turning vehicle-pedestrian traffic lights. Risky conflicts, where motor vehicles violated laws and failed to yield to pedestrians in crosswalk were used as a surrogate for transportation safety. The number of motor vehicles and pedestrians passing through the intersections per second and per meter were used to estimate transportation efficiency. Data were collected and analyzed in 2015 (from March to December). A search of online news from domestic media sources was also conducted to collect pedestrian injury data occurring at the intersections. RESULTS: About one-fourth (57/216) intersections had conflicting left-turning traffic lights (95% CI: 20.5%, 32.3%). Risky vehicle-pedestrian conflicts were more frequently observed at intersections with conflicting lights compared to those without (incidence rate ratio (IRR) = 3.13; pedestrians: IRR = 4.02), after adjusting for type of day (weekday vs. weekend), the time period of observation, and motor vehicles traffic flow. Intersections without conflicting vehicle-pedestrian traffic lights had similar transportation efficiency to those with conflicting lights after controlling for covariates (p > 0.05). The systematic review of news media reports yielded 10 left-turning vehicle-pedestrian crash events between 2011 and 2017, involving 11 moderate or severe pedestrian injuries and 3 fatal pedestrian injuries. CONCLUSION Over one-fourth of road intersections in Changsha city, China have conflicting left-turning traffic lights. Conflicting traffic lights cannot improve transportation efficiency, but increase risky conflicts between vehicles and pedestrians.
Accidents, Traffic ; prevention & control ; statistics & numerical data ; China ; epidemiology ; Cross-Sectional Studies ; Humans ; Motor Vehicles ; statistics & numerical data ; Pedestrians ; statistics & numerical data ; Safety ; Time Factors ; Wounds and Injuries ; epidemiology

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