Situationsanalyse und Maßnahmen zur Prävention von Verkehrsunfällen bei Kindern in Deutschland: Evidenzbasierte Verkehrspolitik in Deutschland?

Die Verkehrssicherheit von Kindern ist ein Kernpunkt des Sicherheitsberichts der Organisation für ökonomische Kooperation und Entwicklung (OECD). In ihrem Bericht Keeping Children Safe in Traffic wird auf erfolgreiche Programme für mehr Sicherheit für Kinder im Straßenverkehr verwiesen. In-wieweit die Empfehlungen in den Mitgliedsstaaten erfolgreich umgesetzt werden, bleibt im Bericht jedoch offen. Ziel der Arbeit ist, eine Basis für die Überprüfung der Evidenz der Verkehrspolitik in Deutschland zu legen. Die vorliegende Situationsanalyse zur Datenlage von Verkehrssicherheitsmaßnahmen für Kinder überprüfte die Daten zwischen 1990 und 2005 zu Verkehrsunfällen von Kindern in Deutschland. Zusätzlich wurden Studien zu ausgewählten Bereichen Verkehrserziehung, Schutzausrüstung, Bau und Raum, Überwachung und Regulation sowie psychologische und soziale Aspekte recherchiert und dem aktuellen Unfallverhütungsbericht der Bundesregierung gegenübergestellt. Alle bearbeiteten Studien wurden tabellarisch zusammengefasst. Darüber hinaus werden Beispiele für eine evidenzbasierte und erfolgreiche Umsetzung von Maßnahmen der Verkehrssicherheit für Kinder auf lokaler Ebene aufgezeigt. Die Analysen der Daten ergaben, dass das Risiko für Kinder zu verunglücken in Deutschland in den vergangenen Jahren eher gestiegen ist. Jedoch wer-den diese Daten in den Bericht der Bundesregierung gegenteilig dargestellt. Dies hängt vor allem von den gewählten Bezugszahlen der Berechnungen ab. Eine erfolgreiche Reduzierung von Unfällen mit Kinderbeteiligung wurde am Beispiel der Stadt Hamm aufgezeigt. In Deutschland bleiben nach dem derzeitigen Kenntnisstand der Arbeit, evi-denzbasierte Verkehrsicherheitsmaßnahmen Einzelmaßnahmen. Um eine evidenzbasierte Verkehrspolitik zu erreichen, bedarf es als Voraussetzung mehr Transparenz der Daten und Studien. Ebenso sollten Forschungsergeb-nisse besser strukturiert und den politischen Entscheidungsträgern in einer leicht zugänglichen und verständlichen Form zur Verfügung stehen. Darüber hinaus sollten die Erfahrungen anderer Länder in der nationalen Verkehrspolitik Berücksichtigung finden. Das in Schweden, Großbritannien und den Niederlanden bereits erklärte Ziel einer Verkehrspolitik mit null Verkehrstoten (Vision Zero) sollte auch in Deutschland selbstverständlich sein. -- Road traffic safety for children is a priority for the Organisation for Economic Co-Operation and Development (OECD). Successful interventions to increase the safety of children were highlighted in their report Keeping children safe in traffic. However, to what extent the successful interventions have been implemented in member states is not reported. The aim of this study is to lay the basis for the analysis of the evidence base of road traffic policy in Germany. This encompasses both an analysis of the current epidemiological situation of road traffic safety for children between 1990 and 2005. In addition, research studies which address topics of traffic education, individual protective measures, urban and traffic design, monitoring and regulation as well as psychological and social factors were reviewed and compared with the most recent Federal Report on Injury Prevention. Best practice examples for the successful implementation of road safety measures for children on the local level are highlighted. The analysis of the available epidemiological data demonstrated that the risk of a child getting injured in traffic has increased during recent years. This is in stark contrast with the most recent report by the Federal Government which stated the contrary. The main reason for this discrepancy is the choice of denominators. A successful example on how to reduce road traffic accidents with injuries of children is given using the city of Hamm. Evidence-based policies to increase road safety for children in Germany are largely missing and are limited to single interventions at the local level. As prerequisites to a comprehensive road safety policy, there is a need for more data transparency and research. Also existing research should be analysed and made available to policy decision-makers in an easy-to-use format. Experiences from other countries should also be used to improve national road safety policies. The objective of reducing road traffic deaths to zero - vision zero adopted by Sweden, the United Kingdom and the Netherlands should also guide German road safety policies.

Psychological profile and self-administered relaxation in patients with craniofacial pain: a prospective in-office study

Introduction: The objective of this study was to evaluate the psychological profile of craniofacial pain sufferers and the impact of patient subtype classification on the short-time effectiveness of a self-administered relaxation training. Methods: One hundred unselected in-office patients (67% females) suffering from chronic facial pain and/or headache with the presumptive diagnose of temporo-mandibular disorder (TMD) completed a questionnaire battery comprising craniofacial pain perception, somatic complaints, irrational beliefs, and pain behavior and were classified into subtypes using cluster analysis. They underwent a self-administered progressive relaxation training and were re-evaluated for pain perception after 3 months. Results: Pain was mild to moderate in the majority of patients. Symptom domains comprised parafunctional activities, temporo-mandibular pain and dysfunction, fronto-temporal headache, head/neck and neck/back pain. Three patient subtypes were identified regarding symptom/dysfunction level: (i) low burden (mild/moderate), (ii) psychosocial dysfunction (moderate/high), (iii) adaptive coping (moderate/mild). Self-rated adherence to the recommended relaxation training was moderate throughout the sample, but self-rated relief was significantly different between clusters. At follow-up, pain intensity was significantly decreased in all patients, whereas pain-related interference was improved only in dysfunctional and adaptive patients. Improvement of symptom domains varied between clusters and was most comprehensive in adaptive patients. Conclusions: In conclusion, craniofacial pain sufferers can be divided in meaningful subtypes based on their pain perception, irrational beliefs, and pain behaviour. A self-administered relaxation training generally yielded positive effects on pain perception, however the benefit may be greater in patients with more marked symptom impact (both dysfunctional and adaptive).<br

Association of dentoskeletal morphology with incisor inclination in angle class II patients: a retrospective cephalometric study

Introduction: The purpose of this study was to identify possible dentoskeletal parameters associated with variation of anterior tooth inclination in Angle Class II subdivisions. Methods: Pre-treatment lateral radiographs of 144 Class II patients (68 males, 76 females) aged 9 to 17 years were classified for upper incisor inclination into three groups (proclined, normally inclined, retroclined) homogeneous for gender and skeletal jaw relationship. The effect of age on the 22 cephalometric variables was controlled by covariance analysis. Results: Multivariate analysis of the cephalometric parameters indicated significant inter-group differences. Systematic associations with incisor inclination were revealed using rank correlation: Lower incisor proclination, Wits appraisal and gonial angle significantly decreased (0.04 ≥ p ≥ 0.002), while intercisal angle, mandibular total and corpus length and nasolabial angle increased (0.04 ≥ p ≥ 0.001) with decreasing incisor proclination. Conclusions: Clear-cut classification criteria and control of confounding effects may clarify conflicting previous findings on dentoskeletal differences between Class II subdivisions in the mixed dentition. Only minor dentoskeletal differences appear to be associated with incisor inclination. The increased interincisal and nasolabial angle in Class II division 2 subjects are due to reclination of both upper and lower incisors. Jaw positions and chin prominence are not significantly different between the subdivisions. However, Wits appraisal is decreased in Class II division 2. The increased mandibular length observed in Class II division 2 requires further scrutinization.<br

Kreisverkehre an Landstraßen

Kreisverkehre außerhalb bebauter Gebiete weisen im Vergleich zu Knotenpunkten mit und ohne LSA eine hohe Verkehrssicherheit auf. Von dem Merkblatt für die Anlage von Kreisverkehren abweichende Entwurfsvorgaben einzelner Bundesländer und ein hoher Anteil Fahrunfälle (insbesondere bei Dunkelheit), weisen jedoch auf ein Potential zur Erhöhung der Verkehrssicherheit durch bessere Erkennbarkeit der Kreisverkehre hin. Im Rahmen des Forschungsprojektes wurde das Unfallgeschehen in Deutschland und drei ausgewählten Bundesländern hinsichtlich der Unfallstruktur an außerörtlichen Kreisverkehren analysiert. Es zeigte sich, dass sich 60 % der Unfälle an außerörtlichen Kreisverkehren während Dämmerung und Dunkelheit ereignen und dass 40 % der Unfälle Alleinunfälle sind. Die Alleinunfälle wiesen dabei die höchste Unfallschwere auf und führen häufig zum Auffahren auf die Kreisinsel. In einer Detailanalyse wurden für 109 Kreisverkehre Lage-, Höhen-, Beschilderungs- und Markierungspläne sowie Verkehrs- und Unfalldaten recherchiert. Unter Verwendung generalisierter linearer Modelle wurde der Einfluss verschiedener Ge¬staltungselemente auf das Unfallgeschehen untersucht. Dabei wurden u. a. folgende Einflussfaktoren identifiziert: • Zufahrten mit Abkröpfung und Verschwenkung im Annäherungsbereich weisen geringere Unfallraten als Zufahrten mit gestreckter Linienführung auf. • Zufahrten mit großem Ablenkungswinkel haben höhere Unfallraten als Zufahrten mit mittlerem Ablenkungswinkel. • Zufahrten mit breitem Fahrbahnteiler in dreieckiger Form weisen geringere Unfallraten als Zufahrten mit schmalem Fahrbahnteiler mit gerader Bordführung auf. Ergänzend wurden Fahrverhaltensanalysen und lichttechnische Untersuchungen an mehr als 30 Kreisverkehrszufahrten durchgeführt. Das beobachtete Geschwindigkeits- und Spurverhalten bestätigt die Erkenntnisse der Unfallanalyse im Hinblick auf die Linienführung im Annäherungsbereich und die Form des Fahrbahnteilers. Anhand der lichttechnischen Analysen (Leuchtdichtemessungen) konnte gezeigt werden, dass durch retroreflektierende Markierungsnägel auf den Bordsteinen der Fahrbahnteiler und der Kreisinsel die Erkennbarkeit von außerörtlichen Kreisverkehren bei Dunkelheit verbessert werden kann.Literature consistently finds a higher level of safety at roundabouts compared to other types of intersections. However, some studies indicate that there is still a lack of safety on rural roundabouts. Particularly high approaching speeds combined with insufficient perceptibility of roundabouts can cause accidents when drivers lose control of their vehicle (especially during nighttime). The goal of this study is to analyze correlates of safety at rural roundabouts in Germany and to investigate opportunities to improve their safety. The analysis of accident characteristics in data from official statistics shows that 60% of all accidents happen in twilight and at night time and that four out of ten accidents are single-vehicle accidents. Single-vehicle accidents have the highest severity and usually end up on the central island of roundabouts. For detailed accident analysis of 109 roundabouts, information on road design, signage, traffic volumes, and accidents was collected for each approach. Using generalized linear models, the following effects of roundabout design on accident risk were found: • Approaches with a curvilinear alignment or a chicane have significant lower accident rates than approaches with straight alignment. • Approaches with high angles of deflection have higher accident rates than approaches with moderate angles of deflection. • Wide splitter islands with triangle shape provide lower accident rates than narrow splitter islands with straight curb.4 Finally, observations of driving behavior and photometric studies were conducted at more than 30 approaches of rural roundabouts. The influence of approach alignment on speed behavior and the shape of splitter islands on track behavior proved the results obtained by the accident analysis. Photometric studies showed that the usage of retroreflective elements on the curb of the splitter island increase the visibility of rural roundabouts during the night

Comparative treatment outcomes after bilateral extractions of maxillary second molars or first premolars in patients with class II malocclusion: a retrospective study

Background This retrospective cohort study aimed to compare treatment results between bilateral extraction of upper second molars (M2) and first premolars (P1) in terms of treatment timing, cephalometry, upper third molar alignment and relapse in the long-term. Methods Fifty-three consecutively treated Caucasian patients with a brachyfacial pattern, skeletal class I and dental class II requiring extraction in the maxilla due to crowding were retrospectively divided into group I (M2 extracted; N = 31) and II (P1 extracted; N = 22). Fixed appliances were inserted after extraction and after distalisation of the first molars in group I. Post-treatment lateral cephalograms were digitally analysed and compared between groups. Six to seven years later relapse and success of upper third molar alignment were clinically evaluated as well as orthodontic treatment duration, pre-treatment age and gender recorded. Results After debonding patients with second molar extraction showed significantly smaller values for the Wits-appraisal, but higher values for index and facial axis. Extracting first premolars caused significantly more retroinclination/−position of anterior teeth and an increased profile concavity, more relapse and less successful alignment of upper third molars. Orthodontic treatment duration, pre-treatment age and gender were not significantly different between groups. Conclusions Bilateral extraction of upper first premolars or second molars may solve dental crowding in skeletal class I dental class II patients with a brachyfacial growth pattern. Upper second molar extraction seems to affect maxillary third molar alignment, long-term stability and dental and soft-tissue cephalometric parameters positively, but no intervention proved to be clearly superior

Occurrence of emerging brominated flame retardants and organophosphate esters in marine wildlife from the Norwegian Arctic

To understand the exposure and potential sources of emerging brominated flame retardants (EBFR) and organophosphate esters (OPEs) in marine wildlife from the Norwegian Arctic, we investigated concentrations of EBFRs in 157 tissue samples from nine species of marine vertebrates and OPEs in 34 samples from three whale species. The samples, collected from a wide range of species with contrasting areal use and diets, included blubber of blue whales, fin whales, humpback whales, white whales, killer whales, walruses and ringed seals and adipose tissue and plasma from polar bears, as well as adipose tissue from glaucous gulls. Tris(2-ethylhexyl) phosphate (TEHP) and tris(2-chloroisopropyl) phosphate (TCIPP) ranged from <0.61 to 164 and < 0.8–41 ng/g lipid weight, respectively, in blue whales and fin whales. All other EBRFs and OPEs were below the detection limit or detected only at low concentration. In addition to the baseline information on the occurrence of EBFRs and OPEs in marine wildlife from the Arctic, we provide an in-depth discussion regarding potential sources of the detected compounds. This information is important for future monitoring and management of EBFRs and OPEs