The syndrome commonly referred to as whiplash injury" resulting from motor vehicle accidents is complex and remains a challenge to clinicians, as is evidenced by the recent report of the Quebec task force on the "whiplash syndrome". The main objective of this prospective randomised study was to evaluate two conservative treatment regimens (early immobilisation-experimental group-1, early active mobilisation experimental group-2) which are based on accepted physiological rationale and then to compare their effectiveness with existing treatment regimens that are commonly practiced (control group) in the management of "whiplash" type of injuries. To this stage, the current study is the only prospective randomised clinical trial of its type conducted with a sufficiently large sample size and over a long study period. The results of the current study clearly demonstrated that the subjects in the immobilised group recovered from their pain-related symptoms and returned to their normal duties sooner than those in the other two treatment groups. In addition to this, those subjects who received the immobilisation regimen did not show adverse effects on either the range of motion or the strength of the neck muscles. Thus, the immobilisation regimen was clearly shown to be the preferred option when compared to the other two treatment methodologies investigated in the current study.Although the primary interest of the current study was to compare the efficacy of three different treatment regimens, a series of statistical analyses were performed to establish the prognostic significance of several factors associated with "whiplash" injury. This showed that factors such as gender, age, speed of the vehicles involved, paraesthesia, intensity of pain at the time of the initial examination, interscapular pain, blurred vision and difficulty in focusing, all had prognostic value. ++ / Similarly, the type of collision, seating position, presence of headache within 24 hours post injury, pre-existing degenerative changes in the cervical spine, loss of lordosis and litigation factors had no prognostic significance. Another major emphasis of the current study has been to concentrate on the pain related symptoms of the neck which are of major concern to "whiplash" subjects and to those clinicians treating them. A paucity of such information is considered to be one of the most notable causes of difficulties encountered in the management of "whiplash" injuries.As an adjunct to the main study, the morphology of the deep pre- and post vertebral muscles of the neck region using embalmed cadavers and fresh post-mortem specimens was investigated, as the literature is deficient in--this regard. Similarly, a longitudinal study of 45 subjects was also performed using Magnetic Resonance Imaging (MRI) technology. The longitudinal nature of the M.R.I. study provided for the first time an account of the details associated with the progressive pathological changes that occurred in some disc lesions, at defined points in time following a MVA. The observations made from the adjunct studies help develop a better understanding of the pathoanatomy associated with the deep muscles of the neck region and the pathological changes that occur following a traumatic disc lesion as evidenced within 2 weeks, after 3 months and 12 months post- injury. On the basis of the observations made in the current study, a classification of the "whiplash" injury has been proposed for the consideration of clinicians. Similarly, the questionnaire used for data collection in the current study, can be readily modified and utilised in a clinical situation for establishing documentation, planning treatment strategies and for evaluation of the treatment outcomes of "whiplash" type of injuries.

Traumatic brain injury (TBI) is considered the “signature injury” for United States Veterans who deployed in support of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) since 2001. Veterans with TBI may be at higher risk for subsequent intentional and unintentional injuries due to cognitive and executive function impairments from the injury and co-occurring psychiatric conditions. This dissertation evaluated the association between TBI and attempted suicide, motor vehicle accidents, and opioid overdose, in a large cohort of United States OEF/OIF/OND Veterans aged 18 to 40 who received care in the Veterans Health Administration (VHA). These studies utilized data from the VHA electronic medical records collected between April 2007 and September 2012. Study 1 evaluated the association between TBI and attempted suicide. Veterans with TBI had approximately a 4-fold increased risk of attempted suicide compared to those without, adjusting for demographics (adjusted hazard ratio (aHR): 3.73, 95% CI = 3.07, 4.53). The mediation analyses suggested that the psychiatric conditions substantially attenuated the impact of TBI on attempted suicide (aHR: 1.25 (95% CI = 1.05, 1.48). Study 2 evaluated the association between TBI and motor vehicle accidents. Veterans with TBI had a 56% increased risk of motor vehicle accident compared to those without, adjusting for demographics (aHR: 1.58, 95% CI = 1.27, 1.97). However, the mediation analyses attenuated this association (aHR: 1.17, 95% CI = 0.96, 1.43). Study 3 evaluated the association between TBI and opioid overdose among OEF/OIF/OND Veterans receiving long-term opioid treatment for non-cancer, chronic pain. Veterans with TBI had 2-fold increased risk for opioid overdose compared to those without, adjusting for demographics (aHR: 2.00, 95% CI = 1.26, 3.16). Nevertheless, the mediation analyses suggested that psychiatric conditions attenuated the impact of TBI on opioid overdose (aHR: 1.38, 95% CI = 0.94, 2.01). In conclusion, these studies add to the literature about risk of intentional and unintentional injuries among Veterans with TBI. Additionally, it highlights that Veterans with TBI and at least one co-morbid psychiatric condition are a particularly vulnerable group with the highest risk for injuries.

Disasters and major accidents are a significant cause of distress worldwide. High levels of posttraumatic stress can become chronic after severe and prolonged psychological trauma, raising concerns about the extent of adverse long-term consequences after single events. The present thesis aimed to describe the course and burden of posttraumatic stress in survivors from a ferry disaster in the Baltic Sea, an airliner crash-landing in Gottröra, Sweden, and a bus accident involving Swedish 6th grade schoolchildren in Måbødalen, Norway. The participants were surveyed 1 month to 4 years after the events and again after 14 to 20 years. The follow-up surveys included 33 ferry disaster survivors, 70 airline survivors, and 7 surviving schoolchildren with a comparison group from the same school (n = 33). Short- and long-term changes in posttraumatic stress were estimated separately in generalised regression models refined by linear splines. In-depth interviews were conducted with 22 ferry survivors 15 years after the disaster, including structured clinical interviews and thematic analysis of survivors’ descriptions of consequences of the event and social support. Approximately half of all survivors experienced significant posttraumatic stress at the initial assessments. Significant long-term distress was noted in one fourth of the ferry survivors and one sixth of the airline survivors. The bus crash was not associated with significant long-term posttraumatic stress. A poorer long-term outcome was noted in women and in bereaved survivors. The thematic analysis revealed that long-term consequences not only included negative aspects but also positive ones, including personal growth and existential awareness. There was ample availability of social support, although the need for support extended over a period of several years. Barriers to support from significant others were described in detail by the survivors. The results extend previous research by providing a comprehensive account of long-term consequences of disasters and major accidents in light of early reactions. The interviews provide some new insights into features of social support that warrant further study. Important future challenges include evaluating whether timely attention to survivors at risk for chronic distress and significant others can facilitate recovery. / Allvarliga händelser som katastrofer eller stora olyckor kan leda till svår psykisk belastning på kort sikt. Svåra posttraumatiska stressreaktioner kan bli beständiga efter svår traumatisering som omsorgssvikt eller övergrepp. Det är därför angeläget att undersöka omfattningen av psykologiska konsekvenser efter enskilda händelser som katastrofer och stora olyckor. Denna avhandling syftade till att beskriva utvecklingen av posttraumatisk stress på lång sikt hos överlevande efter förlisningen av MS Estonia 1994, nödlandingen av ett passagerarflygplan i Gottröra 1991 och efter en olycka med en skolbuss medförande en skolklass från årskurs sex. De överlevande tillskickades enkäter 1 månad till 4 år efter händelsen, samt efter 14 till 20 år. Långtidsenkäterna besvarades av 33 överlevande från färjekatastrofen, 70 från flygolyckan samt 7 överlevande från bussolyckan och 33 personer från parallellklasserna. Intervjuer genomfördes med 22 överlevande 15 år efter färjekatastrofen. Ungefär hälften av alla överlevande upplevde betydande posttraumatiska stressreaktioner vid tidpunkten för den första enkäten. Frekventa stressreaktioner fanns kvar hos 27 % fjorton år efter färjekatastrofen, medan andelen var 16 % nitton år efter flygolyckan. Tjugo år efter bussolyckan upplevde de nu drygt trettioåriga svarande låga nivåer av posttraumatisk stress. Förlustdrabbade överlevande upplevde i genomsnitt en mindre återhämtning under det första året och hade också svårare reaktioner efter många år. Kvinnor upplevde i genomsnitt svårare reaktioner än män såväl på kort sikt som på lång sikt, medan återhämtningen inte skiljde sig åt mellan män och kvinnor. Konsekvenser på lång sikt innefattade enligt de överlevande negativa men också positiva aspekter som personlig mognad och existentiell medvetenhet. De flesta intervjuade hade upplevt gott om stöd från närstående, dock kunde ett visst behov av stöd kvarstå i flera år efter händelsen. Många berättade om hinder för att söka stöd, t.ex. att den närstående var känslomässigt belastad.  Avhandlingen utvidgar det som hittills varit känt om posttraumatisk stress hos överlevande efter katastrofer och stora olyckor. Intervjuerna pekar på viktiga aspekter av socialt stöd att utforska vidare. Resultaten visar att dessa händelser är förknippade med övergående stressreaktioner hos majoriteten av de överlevande. Vidare forskning behövs för att bättre förstå den naturliga återhämtningen och närmare vilka insatser till överlevande och anhöriga som kan underlätta återhämtning. / Long-term posttraumatic stress in survivors from disasters and major accidents

Pochi studi hanno indagato le conseguenze psicologiche di incidenti stradali che coinvolgono adolescenti e giovani adulti (Blanchard at al., 2005; Steil et al., 2001). Attraverso un approccio multi-metodo la ricerca indaga le reazioni psicologiche di genitori e ragazzi ad incidenti stradali, le risposte familiare in grado di svolgere una funzione protettiva e l'impatto psicologico delle modalità di comunicazione del personale sanitario. 50 ragazzi (13/23 anni), vittime di incidenti stradali e i rispettivi genitori hanno risposto a 3 questionari e ad un'intervista narrativa. La reazione dei ragazzi risulta indipendente dalla gravità dell'incidente, mentre la risposta familiare è organizzata in funzione di tale gravità. Emerge un effetto di mediazione della comunicazione del personale sanitario. / Few researches focused on psychological impact of motor vehicle accidents on adolescents and young adults (Blanchard et al., 2005; Steil et al., 2001). This research uses a multi-method approach to explore adolescents' and their parents' psychological reaction to motor vehicle accidents and family patterns protective. The study also investigates the impact of doctors' and nurses' communication strategies. 50 subjects aged 13-23 involved in motor vehicle accidents and their parents answered to 3 questionnaires and a narrative interview. Adolescents' stress response is not related to severity of physical injuries. Severity of physical injuries organizes family answer. The research underlines a mediation effect of doctors' and nurses' communication strategies.

The theme of this student thesis is {\clq}qAnalysis of the machinery as a component of the accident system in the area of traffic operations of self-propelled motor vehicles``. It deals with problems of traffic and main causes of deaths and injuries in road accidents, and proposes a possibility of their elimination. The solution is based on the fact that most of the road accidents are caused by drivers themselves who don´t pay enough attention by driving or their behaviour behind the wheel isn´t sufficient. The proposed solution is supposed to monitor the traffic in real time and in co-operation with specially-designed program installed in the electronic control unit of the vehicle it´s able to notify the driver of dangers around him. The system is also able to dynamically control the traffic in order to prevent traffic-jams, accidents on pedestrian crossings, etc. As a result of system implementation the author estimates rapid decrease in fatal road accidents, serious injuries and physical damages.