As Thornley et al [1] indicate, the use of high-conspicuity aids by
cyclists must be beneficial: motorists can only avoid collision with the
cyclist if they can detect the cyclist.
Unfortunately, high-conspicuity aids are not likely to affect the
visibility of the roadway environment around the cyclist, so motorists'
perceptions of the cyclist's motion and distance will remain poor in
condi...
As Thornley et al [1] indicate, the use of high-conspicuity aids by
cyclists must be beneficial: motorists can only avoid collision with the
cyclist if they can detect the cyclist.
Unfortunately, high-conspicuity aids are not likely to affect the
visibility of the roadway environment around the cyclist, so motorists'
perceptions of the cyclist's motion and distance will remain poor in
conditions of night, fog and precipitation. Laboratory evidence shows
unequivocally that perception of motion requires that the moving object be
viewed against a visible background of other objects; without a visible
background, the threshold for detecting the object's motion is extremely
high [2].
One of the major cues for distance - motion parallax - is also
dependent on a visible background. Motion parallax refers to movement of
the retinal images of viewed objects as a result of the observer's
movement; for example, viewing a distant point entails rates of retinal
image motion inversely proportional to the distance of each of the objects
from the observer. However, motion parallax is ineffective for perceiving
an isolated object's distance [3]. Hence, the cyclist - for example,
performing manoeuvres to left or right at a road junction - must be viewed
against a visible roadway environment for motion parallax to be effective
[4].
The argument presented here is underscored by the clear effectiveness
of street-lighting in the reduction of pedestrian collisions with motor
vehicles [5] - the pedestrian AND the roadway environment are made more
conspicuous. This outcome must extend to cyclists.
The conclusion must be that the value of high-conspicuity aids should
not be overstated: fundamental aspects of the motorist's perception must
remain weak.
References
1. Thornley SJ, Woodward A, Langley JD, Ameratunga SN, Rodgers A.
Conspicuity and bicycle crashes: preliminary findings of the Taupo Bicycle
Study. Inj Prev 2008;14:11-18.
2. Reinhardt-Rutland AH. Induced movement in the visual modality: an
overview. Psychol Bull 1988;103:57-72.
3. Reinhardt-Rutland AH. Motion parallax. In Craighead WE, Nemeroff
CB (eds.). Encyclopedia of psychology and behavioral science (pp 977-979).
New York: Wiley.
4. Reinhardt-Rutland AH. Some implications of motion-perception
evidence and theory for road accidents. J Int Assoc of Traffic and Safety
Sci 1992;16:9-14
5. Retting RA, Ferguson SA, McCartt AT. A review of evidence-based
traffic engineering measures designed to reduce pedestrian-motor vehicle
crashes. Am J Public Health 2003; 93: 1456-1463
The article by Macpherson et al[1] relies on surveys from 111 sites around East York (Toronto) and some questions remain about these surveys. Data from two reports provides confusing indications on the level of cycling. In 2001[2] figures were published for the hourly rate for several years and by comparison in 2003[3] counts for 8-years were provided based on 1 hour observation at each site. An hourly rate...
The article by Macpherson et al[1] relies on surveys from 111 sites around East York (Toronto) and some questions remain about these surveys. Data from two reports provides confusing indications on the level of cycling. In 2001[2] figures were published for the hourly rate for several years and by comparison in 2003[3] counts for 8-years were provided based on 1 hour observation at each site. An hourly rate is calculated base on the 111 sites and 1 hour per site ,'A' divided by 111. The table below shows the data;
Table 1
* data from 2003, 568 wearing helmets from 1227 is 46%, not 45 % as quoted in ref 1.
Robinson [4] stated
"The Canadian study had 111 pre-selected sites, each recorded for one hour, but weather conditions were not reported (though elsewhere 1999 was described as a particularly sunny summer; A K Macpherson, personal communication). Table 1 in the Macpherson et al paper[2] shows that, in some years, some sites were recorded more than once. Moreover, observations were not at the same time of day and day of the week each year (A K Macpherson, personal communication)"
A number of aspects arise,
1) Can extra count details be added to the table, for 1999 and 2001.
2) Why the counts for years 1993 to 1997 were quite different in the published reports.
3) Why the total hours of surveys calculated should vary from 112 hours to 425 hours.
4) Why the observation hours were not a multiply of 111, as per number of sites.
5) Which survey details would be more likely to reflect the true level of cycling activity, 2001 or 2003, if either.
6) Could there have been an 17% drop in cycling, 2003 data - average count pre law 1275, post law 1059.
7) Can other data be added to the table.
8) How reliable are the surveys for indicating the overall level of cycling activity for those aged to 19 years.
9) Helmet use of 46% before legislation is identical to that in 2001 at 46%, seems like no appreciable effect from legislation.
Extra information would help provide a clearer picture to be guided by and most appreciated.
References
1. Macpherson AK, Macarthur C, To TM, et al. Economic disparity in bicycle helmet use by children six years after the introduction of legislation. Inj Prev 2006;12:231-235
2. Macpherson AK, Parkin PC, To TM. Mandatory helmet legislation and children’s exposure to cycling. Inj Prev 2001;7:228–30.
3. Parkin PC, Khambalia A, Kmet L, et al. Influence of socio-economic status on the effectiveness of bicycle helmet legislation for children: a prospective observational study. Pediatrics 2003;112:e192
4. Robinson DL, Helmet laws and cycle use, RESEARCH LETTER, Inj Prev 2003;9:380-381
The paper asserts that the dimunition of risk is due to the increase
in cyclists. Could it be the other way round, that more cycle as it
becomes less risky (due to unknown factors...)?
The risk reduction is purely for cyclists/walkers. Would the
population as a whole experience less risk if they all drove? In extremis,
if all cycled, they would have no cars to collide with, while if none
cycle...
The paper asserts that the dimunition of risk is due to the increase
in cyclists. Could it be the other way round, that more cycle as it
becomes less risky (due to unknown factors...)?
The risk reduction is purely for cyclists/walkers. Would the
population as a whole experience less risk if they all drove? In extremis,
if all cycled, they would have no cars to collide with, while if none
cycled, there would be zero cycling risk.
It would be instructive to know if walkers/cyclists reduced their
risk of heart attacks and other diseases mediated by regular exercise.
Changes in %HI unrelated to %HW
Common sense tells us that if the reduction in head injuries were due to helmet laws, percent head injury (%HI) should decline in response to the increase in percent helmet wearing (%HW).
Fig 1 shows this was not the case either in Ontario or British Columbia (BC), two provinces c...
Changes in %HI unrelated to %HW
Common sense tells us that if the reduction in head injuries were due to helmet laws, percent head injury (%HI) should decline in response to the increase in percent helmet wearing (%HW).
Fig 1 shows this was not the case either in Ontario or British Columbia (BC), two provinces containing 90% of the population of helmet-law provinces in Canada. The greatest decline for BC was a fall of 7.4 percentage points from 94/95 to 95/96 (before the law was enacted). The greatest decline for Ontario (5.4 percentage points) was from 96/97 to 97/98, when helmet wearing was also declining.
The more recent data for Ontario confirm the lack of relationship. The downward trend continues, despite a return to pre-law helmet wearing by 1999. The lowest %HI was for 01/02 when helmet wearing had returned to pre-law levels.
The lack of relationship between %HW and %HI would convince most people that Canada's helmet laws had little benefit, so it is difficult to understand why Macpherson et al. continue to claim:
a) that the data from 94/95 to 97/98 show the laws were effective and
b) we can't draw any useful conclusions from the more recent data, because there is no "concurrent comparison group"[5].
Other road safety measures Even with "concurrent comparison groups", common sense is needed to interpret them correctly. Fig 2 shows a greater declining trend in fatal and serious pedestrian injuries in helmet-law provinces than no-law provinces. The divergence in pedestrian trends obviously wasn't caused by helmet laws. So it seems illogical to claim the trends in %HI (which bear no relationship with the timing of the laws) demonstrate that the Canadian legislation was effective. The trends could have had similar underlying causes (e.g. safer roads) rather than those for cyclists being due simply to helmet laws.
Although bike/motor vehicle collisions (BMVC) cause only a small proportion of total injuries to cyclists, a study of all brain injuries to cyclists in an entire year in San Diego county found that BMVC caused every single fatal or seriously debilitating brain injury.[6] Overall road safety is therefore a major determinant of the risk of debilitating head injury.
A peer-reviewed paper in 1996 showed very strong relationships (r = 0.94, P<_0.02 between="between" hi="hi" of="of" child="child" cyclists="cyclists" and="and" pedestrians="pedestrians" in="in" victoria="victoria" australia.7="australia.7" fell="fell" from="from" _18.3="_18.3" the="the" year="year" before="before" helmet="helmet" law="law" to="to" _10.7="_10.7" second="second" legislation="legislation" compared="compared" a="a" decline="decline" _15.6="_15.6" _13.5="_13.5" for="for" cyclists.7="cyclists.7" greater="greater" strongly="strongly" suggests="suggests" main="main" cause="cause" was="was" not="not" law.="law." p="p"/>These results supersede those of Cameron et al. (1994)[8]. I cannot understand why Macpherson's response to Wardlaw[5] still cites Cameron as evidence that Victoria's helmet law "was effective in reducing head injuries", instead of later research pointing out the significant effects of reduced cycling and large declines in %HI of pedestrians.
Timely reporting of results Finally, Malcolm Wardlaw is correct that timely and accurate reporting of results is important. Numbers counted in the 1999 Ontario survey were published in 2001, but helmet wearing rates for the same year (1999) were not published until August 2006. If, as Macpherson say, she agrees that timely reporting is important, why was the vitally important information that helmet wearing rates returned to pre-law levels by 1999 not mentioned earlier?
If, in 2005, the BMA had known that enforcement in Ontario was ineffective and %HW was at pre-law levels from 1999 onwards, as well as that (as Fig 1 shows) neither the timing of helmet laws nor the changes in %HW bear any relationship with the trends in %HI, their stance on helmet legislation laws might have been different.
References 1. Transport Canada. Road Safety in Canada - 2003. Report prepared for the Canadian Council of Motor Transport Administrators (CCMTA) Standing Committee on Road Safety Research and Policies: Road Safety and Motor Vehicle Regulation Directorate (available at:http://www.tc.gc.ca/roadsafety/tp/tp13951/2003/pdf/tp13951%20EN-S.pdf), 2006.
2. Macpherson AK. An evaluation of the effectiveness of bicycle helmet legislation (powerpoint presentation, available at http://www.circl.pitt.edu/home/webinars/ppt/macphersonwebinar.ppt), 2006.
3. Macpherson AK, Parkin PC, To TM. Mandatory helmet legislation and children's exposure to cycling. Inj Prevent 2001;7(3):228-30.
4. CIHI. Injury Hospitalizations (includes 2000-01 and 2001-02 data): Canadian Institute for Health Information, 2003.
5. Macpherson AK, Macarthur C, To T, Wright J, Chipman M, Parkin P. Reply to Mr. Wardlaw's letter "Timely reporting of research is necessary": E-letter, Injury Prevention http://ip.bmj.com/cgi/eletters/12/4/231#1667, 2007.
6. Kraus JF, Fife D, Conroy C. Incidence, severity, and outcomes of brain injuries involving bicycles. Am J Public Health 1987;77(1):76-8.
7. Hillman M. Health benefits of cycling greatly outweigh loss of life years from deaths. BMJ 1997;314:69.
8. Cameron MH, Vulcan AP, Finch CF, Newstead SV. Mandatory bicycle helmet use following a decade of helmet promotion in Victoria, Australia--an evaluation. Accid Anal Prevent 1994;26(3):325-37.
I offer brief rejoinders to Robertson's critique of my comments:
(a) Robertson may indeed have all the data available for the
specified vehicles in his statistical analysis. Nonetheless, the
theoretical underpinnings in any such statistical analysis assume an
infinite population from which the real-world data are drawn.
(b) I am not an adherent of the risk compensation hypothesis, wh...
I offer brief rejoinders to Robertson's critique of my comments:
(a) Robertson may indeed have all the data available for the
specified vehicles in his statistical analysis. Nonetheless, the
theoretical underpinnings in any such statistical analysis assume an
infinite population from which the real-world data are drawn.
(b) I am not an adherent of the risk compensation hypothesis, which
is normally attributed to Wilde. Rather I find Fuller's [1] learning
theory more satisfying. Whatever one may think about individual theories,
it is certainly the case that engineering interventions can entail
untoward side-effects which can undermine their expected beneficial
effects.
(c) Those who can be adversely affected whatever the merits of
engineering interventions might be are often pedestrians and cyclists. In
the UK and many other European countries, a real problem relating to
obesity arises from the perceived and actual dangers of the roads for
pedestrians and cyclists. Hence, the wide-spread "school run", for example
[2]. This problem is associated - amongst other things - with engineering
interventions designed to improve the conditions for drivers. It will not
likely be reversed by further such interventions.
References
1. Fuller R. On learning to make risky decisions. Ergonomics 1988;
31: 519-526.
2. Hillman M, Adams J, Whitelegg J. 1991. One false move: A study of
children's independent modility. Policy Studies Unit, London.
Point A. The vehicles I studied are not a random sample but all of
the specified vehicles in use (except pickups) during the period studied.
Therefore, random sampling error does not apply. The paper clearly states,
“The mix of vehicles in other countries and the ratios of pedestrians and
bicyclists to motor vehicles would undoubtedly alter the percentages but
it is unlikely that vehicles characteristic...
Point A. The vehicles I studied are not a random sample but all of
the specified vehicles in use (except pickups) during the period studied.
Therefore, random sampling error does not apply. The paper clearly states,
“The mix of vehicles in other countries and the ratios of pedestrians and
bicyclists to motor vehicles would undoubtedly alter the percentages but
it is unlikely that vehicles characteristics would have a different effect
in different countries.” As to some unknown factor being a confounder, I
examined at all the known risk factors that could plausibly explain
effects as large as those found. It behooves those who think otherwise to
identify and research any that they think important rather than whine
about some unknown risk factor.
Point B. The risk compensation hypothesis expounded by Adams and
others has been repeatedly discredited by empirical evidence. See my book,
Injury Epidemiology: Third Edition (Oxford University Press, 2007), pp,
187-194. In my study, death rates to bicyclists and pedestrians were lower
among the more crashworthy vehicles, the opposite of the result predicted
by risk compensation proponents.
Point C. I have no idea what obesity and removing stoplights (based
on a reference to a newspaper article rather than a scientific paper) has
to do with any possible effect of frontal offset and side crash test
results in relation to vehicle impacts with pedestrians and bicyclists.
In discussion of the lower rates of pedestrian and bicyclist deaths
associated with vehicle crashworthiness, I stated in my paper, “ The
significant correlation of reductions in pedestrian and bicyclist deaths
with crash test results suggests the possibility of some degree of
selectivity in buying vehicles that do well on crash tests by drivers less
likely to hit other road users. They may also drive in environments where
there is less exposure to pedestrians and bicyclists.” That is “thought
to the matter”, which I am accused of having avoided.
Robertson [1] has carried out correlational and regressional analyses
of data concerning a number of vehicle factors and death rates of road
users in the United States. Given the sometimes contentious issues that
arise from such analyses, it behoves one to be cautious in what one
concludes from this exercise. I list below three issues that are
pertinent:
Robertson [1] has carried out correlational and regressional analyses
of data concerning a number of vehicle factors and death rates of road
users in the United States. Given the sometimes contentious issues that
arise from such analyses, it behoves one to be cautious in what one
concludes from this exercise. I list below three issues that are
pertinent:
(a) The degree of precision stated for the outcomes is unwarranted.
For example, the precise statement in the Abstract that electronic
stability control would have lowered deaths by 42% over the period of
data collection would not have been appropriate if the sample of raw data
had differed from what was obtained. Such differences can arise from
unforeseen or overlooked predictor variables; even unexplainable random
factors can seriously alter the constants obtained from such model-building [2]. Therefore, less precise figures should be entertained.
(b) The assertions regarding the potential effectiveness of
electronic stability control call to mind comparable assertions in the
United Kingdom over 20 years ago with regard to seat-belt use. Adams [3]
has described the history in relation to the latter in some detail. His
conclusion was that the initial estimates of the safety advantage before
seat-belt use was made compulsory had been squandered after a year or two.
I suggested [4] that the reason concerned the individual and vicarious
learning experiences of drivers after some time in wearing seat-belts: the
potential safety advantage had been lost because drivers have a propensity
to learn more dangerous driving behaviours. The safety advantage had given
way to a performance advantage. Similar arguments seem appropriate in
predicting the long-term effectiveness of electronic stability control.
(c) A final issue must concern the effects on non-motorists,
particularly pedestrians and cyclists - an increasingly important issue
given the issues of obesity and so-called "sustainable travel" [5].
Robertson's assertion towards the end of his paper that "There is no
reason to expect that front and side crashworthiness [of motor vehicles]
would reduce pedestrian and bicyclist deaths" does not indicate that he
has devoted much attention to this issue.
References
[1] Robertson LS. Prevention of motor-vehicle deaths by changing
vehicle factors. Injury Prevention 2007; 13: 307-310.
[2] Green SB, Salkind NJ, Akey TM. Using SPSS for Windows. New
Jersey: Prentice-Hall, 1997.
[3] Adams JGU. Seat belt legislation: the evidence revisited. Safety
Science 1994; 18: 135-152.
[4] Reinhardt-Rutland AH. Behavioural adaptation and seat-belt use: a
hypothesis invoking looming as a negative reinforcer. In: Transportation
and Traffic Theory (A Ceder: ed). Amsterdam: Pergamon.
[5] Temko N. Stop! A London council wants to remove traffic lights
from busy roads. Observer 2007; 30.09.07: 3.
Poudel-Tandukar et al report questionnaire data from a respondent
sample of adolescent pedestrians in Nepal. Coincidentally, Perel et al [1]
have outlined issues relating to road safety in low- and middle-income
countries in the same issue of Injury Prevention.
Commenting in an electronic letter regarding the latter, I asserted
that a pervasive and unhelpful attitude often persists among moto...
Poudel-Tandukar et al report questionnaire data from a respondent
sample of adolescent pedestrians in Nepal. Coincidentally, Perel et al [1]
have outlined issues relating to road safety in low- and middle-income
countries in the same issue of Injury Prevention.
Commenting in an electronic letter regarding the latter, I asserted
that a pervasive and unhelpful attitude often persists among motorists in
developed countries which can be traced back to the earliest days of
motorisation: the relative wealth of motorists gives them high social
influence, which is reflected in - for example - the scapegoating of
pedestrians. Since similar inequalities must surely affect developing
countries, one can conclude that scapegoating of pedestrians is likely to
be endemic in most - if not all - countries, no matter what their
development. Any research concerning pedestrian behaviour should recognise
this issue.
Moreover, let us remember the disproportionate kinetic energy in any
vehicle driven at habitual speeds; indeed, the evidence suggests that
increase in fatalities follows a fourth-power relationship with vehicle
speed [2]. Such evidence must always be borne in mind in any potential
engineering approaches to road safety. For example, increasing pedestrian
use of designated crossings may well entail generally higher traffic
speeds on roads generally, thus putting those pedestrians who still cross
away from designated crossings - whether because of the inconvenient
location of the designated crossing or any other reason - at greater risk.
References
1. Perel P, Ker K, Ivers R et al. Road safety in low- and middle-
income countries: a neglected research area. Inj Prev 2007; 13: 227.
2. Nilsson G. The effect of speed limits on traffic accidents in
Sweden. VTI Report No 68: 1-10. National Road and Traffic Research
Institute. Linkoping, Sweden.
Perel et al (2007) outline some issues relating to research and its
application - up to now largely restricted to high-income countries -
which might inform and moderate the heavy casualty rates among vulnerable
road users that too often follow motorisation in developing economies.
One possible issue - both within the driving community and those
professions charged with reducing casualty rate...
Perel et al (2007) outline some issues relating to research and its
application - up to now largely restricted to high-income countries -
which might inform and moderate the heavy casualty rates among vulnerable
road users that too often follow motorisation in developing economies.
One possible issue - both within the driving community and those
professions charged with reducing casualty rates - concerns the history of
safety-related attitudes in high-income countries. Motoring requires
considerable resources, so in its early phases in a given jurisdiction it
must be the province of those with the greatest wealth - and hence those
likely to have most social influence.
That this influence was important is obvious from well-documented
incidents in the early days of motorisation in high-income countries such
as the UK and US. For example, O'Connell [1] reports that early
pedestrian deaths in Britain were habitually attributed to the
"carelessness" of pedestrians, even if from hindsight such cases were
clearly due to vehicles that were not being driven within their safe
limits.
Arguably such attitudes have never been fully eradicated in these
pioneering countries, although their precise nature may have changed. For
example, the remarkable antagonism to speed-cameras in the UK has been
widely discussed [2]. Indeed, there is a continuing sense that defendants
causing pedestrian injuries and deaths in the UK and US are treated more
leniently in law than defendants causing injuries and deaths by other
means.
In summary, the history of motoring in any country may unfortunately
entail factors which actively hinder the development of an adequate safey
culture among motorists, no matter how "obvious" any interventions might
seem to be.
REFERENCES
1. O'Connell S. The car in British society: Class, gender and
motoring 1896-1939. Manchester University Press, Manchester, 1998.
2. Reinhardt-Rutland A H. Roadside speed-cameras: Arguments for
covert siting. Police J 2001; 74: 312-315.
In 1977 in London, Ontario, when we were only 12 years old, my
'girlfriends' and I used to play a similar game as the 'choking game' in
the school bathroom. We would each take turns helping each other 'faint'.
It started with deep breathing until we were dizzy, then with arms around
your abdomen from the rear; someone would squeeze you until the next
recollection was waking up with a tingling sensatio...
In 1977 in London, Ontario, when we were only 12 years old, my
'girlfriends' and I used to play a similar game as the 'choking game' in
the school bathroom. We would each take turns helping each other 'faint'.
It started with deep breathing until we were dizzy, then with arms around
your abdomen from the rear; someone would squeeze you until the next
recollection was waking up with a tingling sensation all over your body,
on the bathroom floor, completely disoriented. This game has evolved into
something very deadly. I was surprised that young pre-teens risk their
lives with this "secret" game and how it is now responsible for so many
deaths, mistakenly claimed to be suicides. Perhaps the school system could
help save some lives by targeting the age group most likely to engage in
this 'game' by holding a one day 'special guest' seminar to educate them
on the dangers and perhaps offer some alternative, safe activities to
occupy themselves with.
Dear Editor
As Thornley et al [1] indicate, the use of high-conspicuity aids by cyclists must be beneficial: motorists can only avoid collision with the cyclist if they can detect the cyclist.
Unfortunately, high-conspicuity aids are not likely to affect the visibility of the roadway environment around the cyclist, so motorists' perceptions of the cyclist's motion and distance will remain poor in condi...
Dear Editor
The article by Macpherson et al[1] relies on surveys from 111 sites around East York (Toronto) and some questions remain about these surveys. Data from two reports provides confusing indications on the level of cycling. In 2001[2] figures were published for the hourly rate for several years and by comparison in 2003[3] counts for 8-years were provided based on 1 hour observation at each site. An hourly rate...
Dear Editor
The paper asserts that the dimunition of risk is due to the increase in cyclists. Could it be the other way round, that more cycle as it becomes less risky (due to unknown factors...)?
The risk reduction is purely for cyclists/walkers. Would the population as a whole experience less risk if they all drove? In extremis, if all cycled, they would have no cars to collide with, while if none cycle...
Dear Editor
Changes in %HI unrelated to %HW
Common sense tells us that if the reduction in head injuries were due to helmet laws, percent head injury (%HI) should decline in response to the increase in percent helmet wearing (%HW).
Fig 1 shows this was not the case either in Ontario or British Columbia (BC), two provinces c...
Dear Editor
I offer brief rejoinders to Robertson's critique of my comments:
(a) Robertson may indeed have all the data available for the specified vehicles in his statistical analysis. Nonetheless, the theoretical underpinnings in any such statistical analysis assume an infinite population from which the real-world data are drawn.
(b) I am not an adherent of the risk compensation hypothesis, wh...
Dear Editor
Point A. The vehicles I studied are not a random sample but all of the specified vehicles in use (except pickups) during the period studied. Therefore, random sampling error does not apply. The paper clearly states, “The mix of vehicles in other countries and the ratios of pedestrians and bicyclists to motor vehicles would undoubtedly alter the percentages but it is unlikely that vehicles characteristic...
Dear Editor
Robertson [1] has carried out correlational and regressional analyses of data concerning a number of vehicle factors and death rates of road users in the United States. Given the sometimes contentious issues that arise from such analyses, it behoves one to be cautious in what one concludes from this exercise. I list below three issues that are pertinent:
(a) The degree of precision stated for...
Dear Editor
Poudel-Tandukar et al report questionnaire data from a respondent sample of adolescent pedestrians in Nepal. Coincidentally, Perel et al [1] have outlined issues relating to road safety in low- and middle-income countries in the same issue of Injury Prevention.
Commenting in an electronic letter regarding the latter, I asserted that a pervasive and unhelpful attitude often persists among moto...
Dear Editor
Perel et al (2007) outline some issues relating to research and its application - up to now largely restricted to high-income countries - which might inform and moderate the heavy casualty rates among vulnerable road users that too often follow motorisation in developing economies.
One possible issue - both within the driving community and those professions charged with reducing casualty rate...
Dear Editor
In 1977 in London, Ontario, when we were only 12 years old, my 'girlfriends' and I used to play a similar game as the 'choking game' in the school bathroom. We would each take turns helping each other 'faint'. It started with deep breathing until we were dizzy, then with arms around your abdomen from the rear; someone would squeeze you until the next recollection was waking up with a tingling sensatio...
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