Child road trauma poses a preventable public health burden to the community. This PhD research aimed to: 1) quantify the magnitude of child passenger injuries in New South Wales (NSW), Australia; 2) evaluate the effectiveness of different restraint use to prevent fatalities among child passengers; and 3) estimate the benefit in the general child population from different intervention targets relating to restraint use. It comprised two studies to validate methodology and four independent epidemiological studies. The first study to validate methodology assessed the data item availability and categorization across different road traffic injury surveillance data collections in NSW in relation to World Health Organization recommended data item lists and necessary data item lists for road traffic injury research. Exclusion of, or insufficient categorization of, crucial data items such as restraint use and injurious outcome existed for each data collection. The other study to validate methodology assessed the performance (in terms of incidence estimates, sensitivity, and specificity) of several methods for removing multiple counting when conducting analyses on hospital separation data for child passenger injuries under either primary-diagnosis or all-diagnoses based injury definition, using linkage methods as a comparison. The "readmission"-based criterion consistently best approximated the linkage-method-derived incidence rate. Two epidemiological studies used NSW hospital separation datasets and quantified the magnitude of child road trauma in NSW in terms of hospitalisation rates. One study examined the trend in hospitalised injury incidence rates during the period of July 1998 to June 2005 using a non-parametric estimation method, and reported a non-significant decline of hospitalised injuries to child passengers over time. The second study used Poisson regression to demonstrate that rural NSW children were two times more likely to suffer hospitalised injuries compared with their urban counterparts. The third epidemiological study used the Fatality Analysis Reporting Systems (FARS) from the United States (US) and estimated the association between different restraint uses and child passenger fatality using a matched cohort method. Improperly using restraints significantly elevated the risk of death for child passengers involved in a crash compared to any other restraint use. The advantage of child restraints over seat belts in terms of fatality reduction was not statistically significant, although previous studies have shown an advantage for serious injury reduction. The last study was performed to quantify the relative public health benefit in terms of reduction in child passenger deaths and injuries for different interventions relating to restraint use in the general population using a case-based population attributable risk fraction method. Results support the ongoing child restraint legislation change in Australia to require compulsory child restraint uses for children up to their 7th birthday, and an increasing proper use of age-appropriate restraints would provide the greatest reduction in fatalities and injuries among child passengers assuming equal population uptake for all interventions. In conclusion, this thesis demonstrates that child road trauma remains a public health burden to the Australian community; and highlights the importance of properly using age-appropriate restraints in preventing injuries to child passengers.

Child road trauma poses a preventable public health burden to the community. This PhD research aimed to: 1) quantify the magnitude of child passenger injuries in New South Wales (NSW), Australia; 2) evaluate the effectiveness of different restraint use to prevent fatalities among child passengers; and 3) estimate the benefit in the general child population from different intervention targets relating to restraint use. It comprised two studies to validate methodology and four independent epidemiological studies. The first study to validate methodology assessed the data item availability and categorization across different road traffic injury surveillance data collections in NSW in relation to World Health Organization recommended data item lists and necessary data item lists for road traffic injury research. Exclusion of, or insufficient categorization of, crucial data items such as restraint use and injurious outcome existed for each data collection. The other study to validate methodology assessed the performance (in terms of incidence estimates, sensitivity, and specificity) of several methods for removing multiple counting when conducting analyses on hospital separation data for child passenger injuries under either primary-diagnosis or all-diagnoses based injury definition, using linkage methods as a comparison. The "readmission"-based criterion consistently best approximated the linkage-method-derived incidence rate. Two epidemiological studies used NSW hospital separation datasets and quantified the magnitude of child road trauma in NSW in terms of hospitalisation rates. One study examined the trend in hospitalised injury incidence rates during the period of July 1998 to June 2005 using a non-parametric estimation method, and reported a non-significant decline of hospitalised injuries to child passengers over time. The second study used Poisson regression to demonstrate that rural NSW children were two times more likely to suffer hospitalised injuries compared with their urban counterparts. The third epidemiological study used the Fatality Analysis Reporting Systems (FARS) from the United States (US) and estimated the association between different restraint uses and child passenger fatality using a matched cohort method. Improperly using restraints significantly elevated the risk of death for child passengers involved in a crash compared to any other restraint use. The advantage of child restraints over seat belts in terms of fatality reduction was not statistically significant, although previous studies have shown an advantage for serious injury reduction. The last study was performed to quantify the relative public health benefit in terms of reduction in child passenger deaths and injuries for different interventions relating to restraint use in the general population using a case-based population attributable risk fraction method. Results support the ongoing child restraint legislation change in Australia to require compulsory child restraint uses for children up to their 7th birthday, and an increasing proper use of age-appropriate restraints would provide the greatest reduction in fatalities and injuries among child passengers assuming equal population uptake for all interventions. In conclusion, this thesis demonstrates that child road trauma remains a public health burden to the Australian community; and highlights the importance of properly using age-appropriate restraints in preventing injuries to child passengers.

L’attention est un prérequis à l’exécution de la majorité des tâches que nous réalisons au quotidien. Si notre niveau d’attention fluctue naturellement au cours de la journée, de nombreux facteurs peuvent également altérer notre niveau de vigilance (p. ex. alcool, médicaments) ou détourner notre attention (p. ex. téléphone, pensées) et, dès lors, nous exposer à un risque d’accident. En accidentologie routière, les défauts d’attention sont devenus un enjeu de préoccupation majeur, mais des questions demeurent en suspens. Et qu’en est-il des autres traumatismes non intentionnels ? L’objectif de ce travail de thèse était d’étudier le rôle des défauts d’attention dans la survenue de traumatismes non intentionnels. Il s’agissait d’explorer des questions épidémiologiques restées en suspens en accidentologie routière tout en élargissant la problématique à ces accidents moins connus que sont les accidents de la vie courante (AcVC). Pour ce faire, trois axes ont été explorés. Le premier a consisté à étudier le lien entre consommation de médicaments et risque d’accident de la route chez les piétons en s’appuyant sur l’appariement des données sur les remboursements de médicaments de l’Assurance Maladie avec celles sur les accidents de la circulation recueillies par les forces de l’ordre. Dans un second temps, nous nous sommes intéressés à la problématique des différents types de distraction au volant. Cette seconde partie a reposé sur les données d’une étude menée au CHU de Bordeaux. Enfin, un dernier axe a consisté à étudier le rôle des défauts d’attention dans la survenue des AcVC en s’appuyant sur les données d’une cohorte prospective et en ligne sur les AcVC. Dans cette dernière étude, les défauts d’attention ont été étudiés sous l’angle du mind-wandering en tant que trait mesuré par le biais d’un questionnaire ainsi que par l’implémentation de trois tests neuropsychologiques en ligne. Plusieurs classes de médicaments, dont les benzodiazépines, étaient associées à une augmentation du risque d’accident chez les piétons. Dans l’étude sur la distraction au volant, la distraction visuelle a été identifiée comme étant celle qui présentait le plus de risque. Enfin, si aucun lien n’a été trouvé entre les mesures aux tests neuropsychologiques et le risque d’accident de la vie courante, le mind-wandering trait a été associé à une augmentation du risque d’accident de type sports, loisirs et déplacements. Ce travail fournit un éclairage essentiel sur des questions restées jusqu’ici inexplorées. Au-delà des conducteurs et du risque routier, nos résultats indiquent que les défauts d’attention pourraient également présenter un risque pour les piétons ainsi que pour la survenue d’autres accidents du quotidien. Dans les années à venir, la part des défauts d’attention dans la survenue de traumatismes devrait encore croître du fait notamment de l’utilisation croissante des nouvelles technologies dans notre quotidien. Par conséquent, mieux comprendre le rôle de ces défauts d’attention dans la survenue de traumatismes non intentionnels est plus que jamais essentiel. / Attention is a complex process that is required in almost all our daily activities. Beyond its natural fluctuation during the day, our level of attention is also influenced by a large range of factors that can diminish our level of alertness (e.g. medicines, alcohol use) or divert our attention (e.g. mobile phone, thoughts) thus exposing us to the occurrence of unintentional injuries. In road traffic safety, attention failures have been identified as a major cause of concern but questions remain unsolved. What about attentional failures in the occurrence of daily-life injuries ? The aim of this thesis was to explore the role of attention failures on the risk of unintentional injuries. The idea was to explore epidemiological issues that remained unresolved in road traffic injuries while extending the problematic to those lesser-known injuries that are Home and Leisure Injuries (HLIs). To that end, this thesis was divided in three parts. First, we investigated the association between medicine use and the risk of road traffic injuries among pedestrians. To do that, we used data on road traffic crashes collected by the French police forces matching with data on reimbursed medicine from the French Health insurance. In a second part, we were interested in several types of driving distractions on the risk of road traffic crashes using data from a sample of road users interviewed at the Bordeaux University Hospital. The third and final part was to study the role of attentional failures on the occurrence of HLIs and was based on data from a prospective and online cohort on HLIs. Attentional failures were studied from the perspective of mind-wandering as a trait measured through a questionnaire and also the implementation of three online neuropsychological tests. Several medicine classes, including benzodiazepines, were associated with an increased risk of being involved in a road traffic crash as a pedestrian. In the study on distracted driving, the higher risk was found for visual distraction. Finally, whereas neuropsychological test scores were not associated with a higher risk of HLI, mind-wandering trait was associated with a higher risk of sport, leisure and moving-related injuries. This work provides essential insights into issues that have remained unexplored to date. Beyond the drivers and road risk, our results indicate that attentional failures could also present a risk for pedestrians as well as for the occurrence of other everyday injuries. In years, to come, the share of attentional failures in the occurrence of injuries is expected to further increase, particularly due to the increasing use of new technologies in our daily live. Therefore, a better understanding of the role of these attentional failures in the occurrence of unintentional injuries is more than ever essential.

The cost of a road construction over its service life is a function of design, quality of construction as well as maintenance strategies and operations. An optimal life-cycle cost for a road requires evaluations of the above mentioned components. Unfortunately, road designers often neglect a very important aspect, namely, the possibility to perform future maintenance activities. Focus is mainly directed towards other aspects such as investment costs, traffic safety, aesthetic appearance, regional development and environmental effects. This doctoral thesis presents the results of a research project aimed to increase consideration of road maintenance aspects in the planning and design process. The following subgoals were established: Identify the obstacles that prevent adequate consideration of future maintenance during the road planning and design process; and Examine optimisation of life-cycle costs as an approach towards increased efficiency during the road planning and design process. The research project started with a literature review aimed at evaluating the extent to which maintenance aspects are considered during road planning and design as an improvement potential for maintenance efficiency. Efforts made by road authorities to increase efficiency, especially maintenance efficiency, were evaluated. The results indicated that all the evaluated efforts had one thing in common, namely ignorance of the interrelationship between geometrical road design and maintenance as an effective tool to increase maintenance efficiency. Focus has mainly been on improving operating practises and maintenance procedures. This fact might also explain why some efforts to increase maintenance efficiency have been less successful. An investigation was conducted to identify the problems and difficulties, which obstruct due consideration of maintainability during the road planning and design process. A method called “Change Analysis” was used to analyse data collected during interviews with experts in road design and maintenance. The study indicated a complex combination of problems which result in inadequate consideration of maintenance aspects when planning and designing roads. The identified problems were classified into six categories: insufficient consulting, insufficient knowledge, regulations and specifications without consideration of maintenance aspects, insufficient planning and design activities, inadequate organisation and demands from other authorities. Several urgent needs for changes to eliminate these problems were identified. One of the problems identified in the above mentioned study as an obstacle for due consideration of maintenance aspects during road design was the absence of a model for calculating life-cycle costs for roads. Because of this lack of knowledge, the research project focused on implementing a new approach for calculating and analysing life-cycle costs for roads with emphasis on the relationship between road design and road maintainability. Road barriers were chosen as an example. The ambition is to develop this approach to cover other road components at a later stage. A study was conducted to quantify repair rates for barriers and associated repair costs as one of the major maintenance costs for road barriers. A method called “Case Study Research Method” was used to analyse the effect of several factors on barrier repairs costs, such as barrier type, road type, posted speed and seasonal effect. The analyses were based on documented data associated with 1625 repairs conducted in four different geographical regions in Sweden during 2006. A model for calculation of average repair costs per vehicle kilometres was created. Significant differences in the barrier repair costs were found between the studied barrier types. In another study, the injuries associated with road barrier collisions and the corresponding influencing factors were analysed. The analyses in this study were based on documented data from actual barrier collisions between 2005 and 2008 in Sweden. The result was used to calculate the cost for injuries associated with barrier collisions as a part of the socio-economic cost for road barriers. The results showed significant differences in the number of injuries associated with collisions with different barrier types. To calculate and analyse life-cycle costs for road barriers a new approach was developed based on a method called “Activity-based Life-cycle Costing”. By modelling uncertainties, the presented approach gives a possibility to identify and analyse factors crucial for optimising life-cycle costs. The study showed a great potential to increase road maintenance efficiency through road design. It also showed that road components with low investment costs might not be the best choice when including maintenance and socio-economic aspects. The difficulties and problems faced during the collection of data for calculating life-cycle costs for road barriers indicated a great need for improving current data collecting and archiving procedures. The research focused on Swedish road planning and design. However, the conclusions can be applied to other Nordic countries, where weather conditions and road design practices are similar. The general methodological approaches used in this research project may be applied also to other studies.

Varje år skadas många i trafiken. I det fall att den skadelidande och dennes försäkringsbolag inte är överens gällande skadeersättning eller grad av medicinsk invaliditet kan den skadelidande vända sig till Trafikskadenämnden för att få sin sak prövad. Prövningen är kostnadsfri för den skadelidande och avgörs utanför allmän domstol. Men tillvaratas verkligen den skadelidandes intressen på bästa möjliga sätt i Trafikskadenämnden och råder det en rättslig jämvikt mellan konsumenten (den skadelidande) och näringsidkaren (försäkringsbolaget)?Den här uppsatsen ämnar utreda och kartlägga konsumentens intressen i Trafikskadenämnden och huruvida det finns brister och förbättringsmöjligheter i nämndens verksamhet. Att som oförskyllt skadad ställas inför ett sådant omfattande och ensidigt rättsligt arbete som en prövning i nuvarande utformning av Trafikskadenämnden innebär är varken att betraktas som rättvist eller resurseffektivt. / Every year people suffer injuries related to traffic. In the event that the injured party and his or hers insurance company do not agree on the applicable compensation or the degree of medical disability, the injured party can appeal to the Road Traffic Injuries Commission to have their personal case tried. The appeal is free of charge for the injured party and legally processed outside of the civil court system. But is the interest of the injured party safeguarded, and does the commission uphold a legal balance between the consumer (the injured party) and the business operator (insurance company)?This thesis intends to investigate and detect the consumer’s interests in the Road Traffic Injuries Commission and whether there are shortcomings and opportunities for improvement in the commissions function. To be confronted, as an innocent and injured party, with such an extensive and one-sided legal process that the commissions appeal provides, in its current form, is neither to be regarded as legally fair nor resource-efficient.

The cost of a road construction over its service life is a function of design, quality of construction as well as maintenance strategies and operations. An optimal life-cycle cost for a road requires evaluations of the above mentioned components. Unfortunately, road designers often neglect a very important aspect, namely, the possibility to perform future maintenance activities. Focus is mainly directed towards other aspects such as investment costs, traffic safety, aesthetic appearance, regional development and environmental effects. This doctoral thesis presents the results of a research project aimed to increase consideration of road maintenance aspects in the planning and design process. The following subgoals were established: Identify the obstacles that prevent adequate consideration of future maintenance during the road planning and design process; and Examine optimisation of life-cycle costs as an approach towards increased efficiency during the road planning and design process. The research project started with a literature review aimed at evaluating the extent to which maintenance aspects are considered during road planning and design as an improvement potential for maintenance efficiency. Efforts made by road authorities to increase efficiency, especially maintenance efficiency, were evaluated. The results indicated that all the evaluated efforts had one thing in common, namely ignorance of the interrelationship between geometrical road design and maintenance as an effective tool to increase maintenance efficiency. Focus has mainly been on improving operating practises and maintenance procedures. This fact might also explain why some efforts to increase maintenance efficiency have been less successful. An investigation was conducted to identify the problems and difficulties, which obstruct due consideration of maintainability during the road planning and design process. A method called “Change Analysis” was used to analyse data collected during interviews with experts in road design and maintenance. The study indicated a complex combination of problems which result in inadequate consideration of maintenance aspects when planning and designing roads. The identified problems were classified into six categories: insufficient consulting, insufficient knowledge, regulations and specifications without consideration of maintenance aspects, insufficient planning and design activities, inadequate organisation and demands from other authorities. Several urgent needs for changes to eliminate these problems were identified. One of the problems identified in the above mentioned study as an obstacle for due consideration of maintenance aspects during road design was the absence of a model for calculating life-cycle costs for roads. Because of this lack of knowledge, the research project focused on implementing a new approach for calculating and analysing life-cycle costs for roads with emphasis on the relationship between road design and road maintainability. Road barriers were chosen as an example. The ambition is to develop this approach to cover other road components at a later stage. A study was conducted to quantify repair rates for barriers and associated repair costs as one of the major maintenance costs for road barriers. A method called “Case Study Research Method” was used to analyse the effect of several factors on barrier repairs costs, such as barrier type, road type, posted speed and seasonal effect. The analyses were based on documented data associated with 1625 repairs conducted in four different geographical regions in Sweden during 2006. A model for calculation of average repair costs per vehicle kilometres was created. Significant differences in the barrier repair costs were found between the studied barrier types. In another study, the injuries associated with road barrier collisions and the corresponding influencing factors were analysed. The analyses in this study were based on documented data from actual barrier collisions between 2005 and 2008 in Sweden. The result was used to calculate the cost for injuries associated with barrier collisions as a part of the socio-economic cost for road barriers. The results showed significant differences in the number of injuries associated with collisions with different barrier types. To calculate and analyse life-cycle costs for road barriers a new approach was developed based on a method called “Activity-based Life-cycle Costing”. By modelling uncertainties, the presented approach gives a possibility to identify and analyse factors crucial for optimising life-cycle costs. The study showed a great potential to increase road maintenance efficiency through road design. It also showed that road components with low investment costs might not be the best choice when including maintenance and socio-economic aspects. The difficulties and problems faced during the collection of data for calculating life-cycle costs for road barriers indicated a great need for improving current data collecting and archiving procedures. The research focused on Swedish road planning and design. However, the conclusions can be applied to other Nordic countries, where weather conditions and road design practices are similar. The general methodological approaches used in this research project may be applied also to other studies. / <p>QC 20110407</p>

MENVSC / Department of Geography and Geo-Information Sciences / Road transport safety is challenging globally, especially in developing countries, where it affects both road users and governments. The aim of road traffic safety is to ensure a reduction or total eradication of road fatalities and other injuries that are related to road accidents resulting from public road usage. In South Africa, one of the major problems faced by the Department of Roads and Transport is the issue of road traffic accidents. Between 2004 and 2010 the annual road traffic accidents increased to over 500,000 and 28,000 or more are fatal, which has led to serious injuries, as reported by the Department. This study analysed patterns and trends of road traffic injuries and fatalities in Vhembe District Municipality from January 2011 to August 2015. It also mapped road accident hotpots using Getis hotspot analysis and linear referencing in ArcGIS 10.2 spatial statistics extension. The research further established correlation between accidents spots and road design geometry. Factors that are responsible for road traffic accidents leading to fatalities, injuries, and loss of property were also examined. Pedestrian behavioural attitude towards adhering to road safety measures was studied using systematic random sampling, field observation and questionnaires. Finally, the study investigated if there has been any significant reduction in the road traffic injuries and fatalities occurrence rate within the last five years in Vhembe District since the commencement of World Health Organisation; Decade of Action for Road Safety 2011-2020. It was found out that most of the accidents occurred as a result of changes in human social behaviour, negligence and indulgence. The passenger road users category is the worst affected followed by drivers and pedestrians. It was found out that road crashes have decreased by 35% since the commencement of decade of action for road safety. The composition of road traffic injuries and fatalities since 2011 shows a reduction in the numbers of victims recorded. An average of 86 fatalities, 326 serious injuries and 701 minor injuries occurred per annum within the study period. There was high significant value (p  0.05) among all the categories of road users understudied. The differences observed were real and did not occurred by chance for the 5year period (2011 – 2015).