Effect of motorcycle rider education on changes in risk behaviours and motorcycle-related injuries in rural Thailand. The impact of two related prevention strategies on head injury reduction among nonfatally injured motorcycle riders, California, 1991-1993. Effect of simulator training on driving after stroke: a randomized controlled trial. Helmet effectiveness in preventing motorcycle driver and passenger fatalities. The effectiveness of parents in promoting the development of road crossing skills in young children. Specific and long-term effects of Nova Scotia's graduated licensing program. Can training bar staff in responsible serving practices reduce alcohol-related harm? The association of helmet use with the outcome of motorcycle crash injury when controlling for crash/injury severity. Effectiveness of the training program for workers at construction sites of the high-speed railway line between Torino and Novara: impact on injury rates.
A community-based programme for motorcycle rider education was provided for motorcyclists in all villages of 3 randomly selected subdistricts in Mae Sot District, Tak Province, northern Thailand, between January and March 1995. To determine the extent of changes in risk-taking behaviours, we conducted an interview survey of motorcyclists in 3 villages selected by systematic sampling from the 3 intervention subdistricts and in 3 control (without intervention) villages for comparison in March 1997, 2 years after the programme. Motorcyclists in the intervention villages (69.7%) were significantly more likely to have valid licences than those in the control villages (46.5%). The proportion of motorcyclists who always or often wore helmets was significantly greater in the intervention sample (46.0%) than in the control sample (20.5%). In 1994, the annual incidence rate of motorcycle-related injuries was slightly higher in the intervention areas than in the control areas Following the education programme, the injury rates for 1995 and 1996 were significantly lower in the intervention than in the control population. The annual number and rate of fatal motorcycle injuries decreased after the intervention although there was no significant difference between the two populations. Motorcycle rider education may be a promising intervention for prevention of motorcycle-related injuries in rural areas where road safety measures, particularly enforcement activities, are commonly limited. Although the traumatic injury death rate in the United States decreased during the last 20 years, the percent of all injury deaths attributable to brain injuries has remained steady. Head injuries are a leading cause of injury among motorcycle riders in crashes, and the helmet is an effective measure to reduce these injuries. To reduce the burden and cost of motorcycle injuries, many states have increased helmet use by introducing mandatory helmet legislation. This report presents evidence on the effects of the motorcycle helmet and helmet use legislation--two interrelated prevention strategies which decrease traumatic brain injury among motorcycle riders. Nonfatally injured motorcyclists were included if they crashed between January 1, 1991 and December 31, 1993 and were treated in one of 18 hospitals in 10 California counties. Medical records for all injured motorcyclists admitted to these 18 hospitals and those treated in the emergency department and released in eight of these hospitals were individually reviewed. Complete lists of injury diagnoses for each rider were coded according to the 1990 Abbreviated Injury Severity Scale by trained clinical staff. Before the universal helmet law was introduced (when only a third of injured riders wore helmets) 38.2% of riders sustained head injuries. When helmet use increased to over 85% of injured riders following the law, less than 25% of riders sustained head injuries. Both the severity and the number of head injuries per individual rider decreased after the mandatory helmet use law led to increased helmet use. Riders wearing helmets suffered fewer skull fractures, fewer intracranial injuries, had less frequent and shorter periods of loss of consciousness, more favorable GCS scores, and shorter hospital stays. Mandatory motorcycle helmet use laws are an effective mechanism to increase helmet use among riders and thus prevent head and brain injuries resulting from motorcycle crashes. Neurologically impaired persons seem to benefit from driving-training programs, but there is no convincing evidence to support this notion. The authors therefore investigated the effect of simulator-based training on driving after stroke.
                Eighty-three first-ever subacute stroke patients entered a 5-week 15-hour training program in which they were randomly allocated to either an experimental (simulator-based training) or control (driving-related cognitive tasks) group. Performance in off-road evaluations and an on-road test were used to assess the driving ability of subjects pre- and post-training. Outcome of an official predriving assessment administered 6 to 9 months poststroke was also considered.
                Both groups significantly improved in a visual and many neuropsychological evaluations and in the on-road test after training. There were no significant differences between both groups in improvements from pre- to post-training except in the "road sign recognition test" in which the experimental subjects improved more. Significant improvements in the three-class decision ("fit to drive," "temporarily unfit to drive," and "unfit to drive") were found in favor of the experimental group post-training. Academic qualification and overall disability together determined subjects that benefited most from the simulator-based driving training. Significantly more experimental subjects (73%) than control subjects (42%) passed the follow-up official predriving assessment and were legally allowed to resume driving.
                Simulator-based driving training improved driving ability, especially for well educated and less disabled stroke patients. However, the findings of the study may have been modified as a result of the large number of dropouts and the possibility of some neurologic recovery unrelated to training. Helmet effectiveness in preventing fatalities to motorcycle drivers and passengers was determined by applying the double pair comparison method to the Fatal Accident Reporting System (FARS) data for 1975 through 1986. Motorcycles with a driver and a passenger, at least one of whom was killed, were used. In order to reduce as much as possible potentially confounding effects due to the dependence of survivability on sex and age, the analysis is confined to male drivers (there were insufficient female driver data), and to cases in which the driver and passenger age do not differ by more than three years. Motorcycle helmet effectiveness estimates are found to be relatively unaffected by performing the analyses in a number of ways different from that indicated above. It was found that helmets are (28 +/- 8)% effective in preventing fatalities to motorcycle riders (the error is one standard error), the effectiveness being similar for male and female passengers, and similar for drivers and passengers. An additional result found was that the fatality risk in the driver seat exceeds that in the passenger seat by (26 +/- 2)%. The 28% effectiveness found generates calculated fatality increases from repeal of mandatory helmet-wearing laws that are compatible with observed increases. Young children show poor judgment when asked to select a safe place to cross the road, frequently considering dangerous sites to be safe. Correspondingly, child pedestrian accidents are over-represented at such locations. Increasing the child's ability to recognise such dangers is a central challenge for road safety education.
                Practical training methods have proved effective in improving such judgments but are labour-intensive, time-consuming and therefore difficult to implement on a realistic scale. The study examined the possibility that volunteers from the local community might be capable of using such methods to promote children's pedestrian competence.
                Sixty children from the Primary 1 (Reception) classes of three Glasgow schools took part. Volunteers were ordinary parents from the same areas. None had 'formal' experience of working with children other than through being parents.
                Volunteers received experience of training children at courses organised in each school. Children learned in small groups, receiving two sessions of roadside training followed by four on a table-top model. Pre- and post-tests allowed the effectiveness of training to be assessed.
                Significant improvements relative to controls were found in all children following training. Improvements proved robust and no deterioration was observed two months after the programme ended. Comparison with a previous study in which training was undertaken by highly qualified staff showed that the volunteers were as effective as 'expert' trainers.
                Parent volunteers can significantly increase the pedestrian competence of children as young as five years. They constitute a most valuable 'resource' in road safety education. The opportunities afforded by involving the local community in educational interventions should be further explored. A graduated licensing (GL) program was introduced in Nova Scotia, Canada, in October 1994. Previous research has shown that it reduced collisions in the short term. The present study examined the relative contribution of each stage of the program (i.e., learner and intermediate levels) and the program's impact after beginning drivers graduated to full licensure. The research focused on teenage beginning drivers (age 16-17), but the effects on older beginners also was examined. Per-driver crash rates of two groups of novices selected from driver records in Nova Scotia were compared. One group (pre-GL) received their learner's permits during the 2 years before the program was implemented, and the second group (GL) received their learner's permits during the 2 years after implementation. The findings clearly establish that most of the collision reduction in Nova Scotia's program occurred during the first year of the program, particularly during the first 6 months when the majority of novices were driving under supervision. The collision rate for 16 to 17-year-old GL novices was 50% lower than the rate for pre-GL novices during the 6 months after they received their learner's permits, and about 10% lower during their first 2 years of licensure when unsupervised driving from midnight to 5 A.M. was prohibited. Much of this improvement for 16 to 17-year-olds occurred during restricted night hours. Collision rates also were lower during nonrestricted hours in the initial 6 months of licensure. The 3-month "time discount" for driver education provided no safety benefit, and GL novices with driver education had collision rates that were not lower than pre-GL novices. There was no long-term effect found for the program after 16 to 17-year-olds graduated to full licensure. For older beginning drivers, crash rates during the first year after obtaining a learner's permit showed a 31% reduction. This effect diminished rapidly. There was only a 2% reduction during the first year of licensure, and crash rates increased during the following 2 years. Overall the data indicate substantial benefits of graduated licensing for 16 to 17-year-old beginners, but no benefits beyond the learner stage for older beginners. A responsible service training programme aimed at reducing alcohol-related harm was implemented in a popular entertainment area over several months in 1992-93. Another popular entertainment area provided a control site. A number of evaluation measures were used: breath tests on 872 patrons from selected venues; drink driving data; risk assessments; the use of 'pseudo patrons'; and knowledge and attitude changes among trained bar staff (n = 88). Compared to control sites the intervention sites showed an immediate pre- to post-test reduction in patrons rated by researchers as extremely drunk and an eventual reduction from pre-test to follow-up in patrons with blood alcohol levels > = 0.08. There was also a small but significant increase in knowledge among bar staff. There was no significant reduction in patrons with blood alcohol levels > = 0.15 or in the number of drink driving offences from intervention sites during the study period. Pseudo drunk patrons were rarely refused service, identification was rarely checked and non-photographic identification was accepted on most occasions. The less than satisfactory outcome is attributed to poor implementation of the training and a lack of support among managers. The positive results from one venue, whose manager embraced the programme, served to highlight the importance of management support. It is suggested that mandatory training and routine enforcement of licensing laws are essential if the goals of responsible serving are to be met. Many studies have reported that helmet use by motorcycle riders significantly decreases their risk of head injury, death, and disability in the event of a crash. However, these studies have not controlled for crash severity and thus do not conclusively show the value of helmet use by motorcycle riders. Using data from a statewide trauma registry, the present study examines the association of helmet use with various outcomes of motorcycle crashes, controlling for overall crash severity as measured by a modified Injury Severity Score. The results show that in crashes where the overall degree of injury was comparable, the risk of head injury in hospitalized motorcyclists was nearly twice as high for unhelmeted riders as it was for helmeted riders, thus confirming the protective effects of helmet use. However, there were no significant differences in various measurements of resource utilization, including days in hospital, hospital charges, and need for post-hospital rehabilitation. A higher incidence of extremity injuries among the helmeted riders may account for their failure to demonstrate consistently lower resource utilization, despite lower rates of head injury. There are very few published studies evaluating the impact of safety and health training on injury outcomes in the construction industry. The aim of this study was to assess the impact of the training program on injury rates at a major railway construction project.
                The population consisted of 2,795 workers involved in a safety training program at the construction sites of the high-speed railway line Torino-Novara. Two types of analyses were carried out in order to assess the effectiveness of the training program in reducing the number of injuries: (i) a pre-post analysis, which took into account the fact that workers were enrolled at different times and the training intervention did not occur at the same time for all subjects; (ii) an interrupted time-series model, which corrected for the time trend and considered the autocorrelation between individual observations.
                Twenty-nine percent of workers who spent at least 1 day at the construction sites attended at least one training module. Pre-post analysis: At the end of the training program, the incidence of occupational injuries had fallen by 16% after the basic training module and by 25% following the specific modules. Time-series model: Training led to a 6% reduction in injury rates, which was not statistically significant.
                The training program that was implemented had a moderately positive impact on the health of workers. Further studies are being conducted to obtain a more complete assessment of the actual effectiveness of the program in reducing the incidence of injuries.
                Copyright 2009 Wiley-Liss, Inc.
Due to the poor quality of studies identified, we were unable to draw any conclusions about the effectiveness of rider training on crash, injury, or offence rates. The findings suggest that mandatory pre-licence training may be an impediment to completing a motorcycle licensing process, possibly indirectly reducing crashes through a reduction in exposure. It is not clear if training (or what type) reduces the risk of crashes, injuries or offences in motorcyclists, and a best rider training practice can therefore not be recommended. As some type of rider training is likely to be necessary to teach motorcyclists to ride a motorcycle safely, rigorous research is needed.