What Influences the Association between Previous and Future Crashes among Cyclists? A Propensity Score Analysis

<div><p>Background</p><p>It is known that experience of a previous crash is related to incidence of future crashes in a cohort of New Zealand cyclists. This paper investigated if the strength of such association differed by crash involvement propensity and by the need for medical care in the previous crash.</p><p>Methods</p><p>The Taupo Bicycle Study involved 2590 adult cyclists recruited in 2006 and followed over a median period of 4.6 years through linkage to four national databases. The crash involvement propensity was estimated using propensity scores based on the participants' demographic, cycling and residential characteristics. Cox regression modelling for repeated events was performed with multivariate and propensity score adjustments. Analyses were then stratified by quintiles of the propensity score.</p><p>Results</p><p>A total of 801 (31.0%) participants reported having experienced at least one bicycle crash in the twelve months prior to the baseline survey. They had a higher risk of experiencing crash events during follow-up (hazard ratio (HR): 1.43; 95% CI: 1.28, 1.60) but in the stratified analysis, this association was significant only in the highest two quintiles of the propensity score where the likelihood of having experienced a crash was more than 33%. The association was stronger for previous crashes that had received medical care (HR 1.63; 95% CI: 1.41, 1.88) compared to those that had not (HR 1.30; 95% CI: 1.14, 1.49).</p><p>Conclusions</p><p>Previous crash experience increased the risk of future crash involvement in high-risk cyclists and the association was stronger for previous crashes attended medically. What distinguishes the high risk group warrants closer investigation, and the findings indicate also that health service providers could play an important role in prevention of bicycle crash injuries.</p></div

Predicted and observed probability of reporting a bicycle crash history per quintile of the propensity score.

<p>* Range of propensity scores.</p

Associations between previous crash experience and subsequent crash involvement per quintile of the propensity score.

<p>a The reference group comprise participants without previous crash experience.</p

Bicycle crashes experienced during follow-up.

<p>Bicycle crashes experienced during follow-up.</p

A system approach to ensuring cycling safety in New Zealand

This article is part of the Proceedings of the 6th Annual International Cycling Safety Conference held in Davis, California, USA on September 20th through 23rd in the year 2017.<br><br>Paper ID: 4

Heat-Attributable Deaths between 1992 and 2009 in Seoul, South Korea

<div><p>Background</p><p>Climate change may significantly affect human health. The possible effects of high ambient temperature must be better understood, particularly in terms of certain diseases’ sensitivity to heat (as reflected in relative risks [RR]) and the consequent disease burden (number or fraction of cases attributable to high temperatures), in order to manage the threat.</p><p>Purpose</p><p>This study investigated the number of deaths attributable to abnormally high ambient temperatures in Seoul, South Korea, for a wide range of diseases.</p><p>Method</p><p>The relationship between mortality and daily maximum temperature using a generalized linear model was analyzed. The threshold temperature was defined as the 90^th percentile of maximum daily temperatures. Deaths were classified according to ICD-10 codes, and for each disease, the RR and attributable fractions were determined. Using these fractions, the total number of deaths attributable to daily maximum temperatures above the threshold value, from 1992 to 2009, was calculated. Data analyses were conducted in 2012–2013.</p><p>Results</p><p>Heat-attributable deaths accounted for 3,177 of the 271,633 deaths from all causes. Neurological (RR 1.07; 95% CI, 1.04–1.11) and mental and behavioral disorders (RR 1.04; 95% CI, 1.01–1.07) had relatively high increases in the RR of mortality. The most heat-sensitive diseases (those with the highest RRs) were not the diseases that caused the largest number of deaths attributable to high temperatures.</p><p>Conclusion</p><p>This study estimated RRs and deaths attributable to high ambient temperature for a wide variety of diseases. Prevention-related policies must account for both particular vulnerabilities (heat-sensitive diseases with high RRs) and the major causes of the heat mortality burden (common conditions less sensitive to high temperatures).</p></div

Descriptive Statistics of meteorological variables (1992–2009) and air pollutants (2001–2009).

<p>Descriptive Statistics of meteorological variables (1992–2009) and air pollutants (2001–2009).</p

Estimated relative risk of mortality for every 1°C increase in temperature above the 29.5°C threshold from May through September, 1992–2009.

<p>Estimated relative risk of mortality for every 1°C increase in temperature above the 29.5°C threshold from May through September, 1992–2009.</p

Estimated number of deaths attributable to heat and estimated relative risk of mortality for a 1°C increase in temperature above the threshold temperature (29.5°C).

<p>^a Attributable death / Number of death from specific causes: Proportion of attributable death to each cause of death.</p><p>^b Attributable death / Total number of death: Proportion of attributable deaths to total number of death.</p><p>Estimated number of deaths attributable to heat and estimated relative risk of mortality for a 1°C increase in temperature above the threshold temperature (29.5°C).</p

Climate change, mental health and wellbeing: privileging Pacific peoples’ perspectives – phase one

Impacts of climate change in the Pacific are far reaching and include effects on mental health and wellbeing. Pacific concepts around the interrelation of these global giants are yet to be described. The aim of this study was to seek consensus amongst Pacific mental health and/or climate change experts on key principles underpinning mental health and wellbeing, and climate change, and the intersection of the two, for Pacific peoples. The Delphi method included forming a panel of 70 experts. Two rounds of online questionnaires sought their views on mental health and wellbeing, and climate change and the impact upon Pacific peoples. Of the panel 86% identified with one or more Pacific ethnicities. Six themes emerged, 92% of items reached consensus and 36% reached strong consensus of >95%. Recurring subthemes included culture and spirituality, family and community, connection to ancestors, connection to the environment, resilience, disasters, livelihoods, government, education, workforce, migration and stigma. This is the first time these concepts have been explored and described for, and by Pacific peoples in this format. It is a necessary first step towards development of responses in preparedness of mental health services, in the Pacific region, and Aotearoa New Zealand.</p