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      Severity of urban cycling injuries and the relationship with personal, trip, route and crash characteristics: analyses using four severity metrics

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          Abstract

          Objective

          To examine the relationship between cycling injury severity and personal, trip, route and crash characteristics.

          Methods

          Data from a previous study of injury risk, conducted in Toronto and Vancouver, Canada, were used to classify injury severity using four metrics: (1) did not continue trip by bike; (2) transported to hospital by ambulance; (3) admitted to hospital; and (4) Canadian Triage and Acuity Scale (CTAS). Multiple logistic regression was used to examine associations with personal, trip, route and crash characteristics.

          Results

          Of 683 adults injured while cycling, 528 did not continue their trip by bike, 251 were transported by ambulance and 60 were admitted to hospital for further treatment. Treatment urgencies included 75 as CTAS=1 or 2 (most medically urgent), 284 as CTAS=3, and 320 as CTAS=4 or 5 (least medically urgent). Older age and collision with a motor vehicle were consistently associated with increased severity in all four metrics and statistically significant in three each (both variables with ambulance transport and CTAS; age with hospital admission; and motor vehicle collision with did not continue by bike). Other factors were consistently associated with more severe injuries, but statistically significant in one metric each: downhill grades; higher motor vehicle speeds; sidewalks (these significant for ambulance transport); multiuse paths and local streets (both significant for hospital admission).

          Conclusions

          In two of Canada's largest cities, about one-third of the bicycle crashes were collisions with motor vehicles and the resulting injuries were more severe than in other crash circumstances, underscoring the importance of separating cyclists from motor vehicle traffic. Our results also suggest that bicycling injury severity and injury risk would be reduced on facilities that minimise slopes, have lower vehicle speeds, and that are designed for bicycling rather than shared with pedestrians.

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          Most cited references31

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          Active commuting and cardiovascular risk: a meta-analytic review.

          Leisure time physical activity is inversely associated with cardiovascular risk, although evidence for the protective effects of active commuting is more limited. The present review examines evidence from prospective epidemiological studies of commuting activity and cardiovascular risk. Meta-analytic procedures were performed to examine the association between commuting physical activity and cardiovascular risk. Several cardiovascular endpoints were examined including mortality, incident coronary heart disease, stroke, hypertension and diabetes. We included eight studies in the overall analysis (173,146 participants) that yielded 15 separate risk ratios (RR). The overall meta-analysis demonstrated a robust protective effect of active commuting on cardiovascular outcomes (integrated RR=0.89, 95% confidence interval 0.81-0.98, p=0.016). However, the protective effects of active commuting were more robust among women (0.87, 0.77-0.98, p=0.02) than in men (0.91, 0.80-1.04, p=0.17). Active commuting that incorporates walking and cycling was associated with an overall 11% reduction in cardiovascular risk, which was more robust among women. Future studies should investigate the reasons for possible gender effects and also examine the importance of commuting activity intensity.
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            Modern triage in the emergency department.

            Because the volume of patient admissions to an emergency department (ED) cannot be precisely planned, the available resources may become overwhelmed at times ("crowding"), with resulting risks for patient safety. The aim of this study is to identify modern triage instruments and assess their validity and reliability. Review of selected literature retrieved by a search on the terms "emergency department" and "triage." Emergency departments around the world use different triage systems to assess the severity of incoming patients' conditions and assign treatment priorities. Our study identified four such instruments: the Australasian Triage Scale (ATS), the Canadian Triage and Acuity Scale (CTAS), the Manchester Triage System (MTS), and the Emergency Severity Index (ESI). Triage instruments with 5 levels are superior to those with 3 levels in both validity and reliability (p<0.01). Good to very good reliability has been shown for the best-studied instruments, CTAS and ESI (κ-statistics: 0.7 to 0.95), while ATS and MTS have been found to be only moderately reliable (κ-statistics: 0.3 to 0.6). MTS and ESI are both available in German; of these two, only the ESI has been validated in German-speaking countries. Five-level triage systems are valid and reliable methods for assessment of the severity of incoming patients' conditions by nursing staff in the emergency department. They should be used in German emergency departments to assign treatment priorities in a structured and dependable fashion.
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              Promoting walking and cycling as an alternative to using cars: systematic review.

              To assess what interventions are effective in promoting a population shift from using cars towards walking and cycling and to assess the health effects of such interventions. Published and unpublished reports in any language identified from electronic databases, bibliographies, websites, and reference lists. Systematic search and appraisal to identify experimental or observational studies with a prospective or controlled retrospective design that evaluated any intervention applied to an urban population or area by measuring outcomes in members of the local population. 22 studies met the inclusion criteria. We found some evidence that targeted behaviour change programmes can change the behaviour of motivated subgroups, resulting (in the largest study) in a shift of around 5% of all trips at a population level. Single studies of commuter subsidies and a new railway station also showed positive effects. The balance of best available evidence about publicity campaigns, engineering measures, and other interventions suggests that they have not been effective. Participants in trials of active commuting experienced short term improvements in certain measures of health and fitness, but we found no good evidence on effects on health of any effective intervention at population level. The best available evidence of effectiveness in promoting a modal shift is for targeted behaviour change programmes, but the social distribution of their effects is unclear and some other types of intervention have yet to be rigorously evaluated.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2015
                5 January 2015
                : 5
                : 1
                : e006654
                Affiliations
                [1 ]Department of Mechanical Engineering, University of British Columbia , Vancouver, Canada
                [2 ]School of Population and Public Health, University of British Columbia , Vancouver, Canada
                [3 ]Department of Emergency Medicine, University of British Columbia , Vancouver, Canada
                [4 ]Dalla Lana School of Public Health, University of Toronto , Toronto, Canada
                [5 ]Faculty of Medicine, University of Toronto , Toronto, Canada
                [6 ]University Health Network , Toronto, Canada
                [7 ]School of Occupational and Public Health, Ryerson University , Toronto, Canada
                [8 ]Faculty of Health Sciences, Simon Fraser University , Burnaby, Canada
                [9 ]Institute for Resources, Environment and Sustainability, University of British Columbia , Vancouver, Canada
                [10 ]Division of Neurosurgery and Injury Prevention Research Office, Keenan Research Centre, St. Michael's Hospital , Toronto, Canada
                [11 ]Departments of Surgery and Education and Public Health, University of Toronto , Toronto, Canada
                [12 ]Department of Pediatrics, University of British Columbia , Vancouver, Canada
                Author notes
                [Correspondence to ] Dr Kay Teschke; kay.teschke@ 123456ubc.ca
                Author information
                http://orcid.org/0000-0002-7871-3583
                Article
                bmjopen-2014-006654
                10.1136/bmjopen-2014-006654
                4289714
                25564148
                e0e6d7d0-fb1d-4f26-bf33-71b475a87a26
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 16 September 2014
                : 26 November 2014
                : 11 December 2014
                Categories
                Emergency Medicine
                Research
                1506
                1691
                1736

                Medicine
                epidemiology,accident & emergency medicine,public health
                Medicine
                epidemiology, accident & emergency medicine, public health

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