Rozprawy doktorskie na temat „Disorderly traffic”

Thesis (Ph. D.)--West Virginia University, 1999.
Title from document title page. Document formatted into pages; contains x, 112 p. : ill. (some col.). Vita. Includes abstract. Includes bibliographical references (p. 62-73).

Objectives: - The present research attempts to elicit children's perceptions and experiences of enduring a road traffic accident (RTA). It also examined their parents experiences of parenting such children and their own experiences and perceptions of the accident. Participants: - The study focussed on 14 children, aged from 9 years 9 months - 14 years and 4 months of age who had endured a RTA from between 9-33 months previously and their parents. Design: - The study employed a non-experimental design with a combination of quantitative and qualitative paradigms. Method: - The participants were identified via the hospital database of all children who had endured a RTA from between 6-24 months previously. Both the children and their parents were interviewed on specifically designed semi-structured interview schedules. Each interview was then tape-recorded and transcribed in its entirety. These transcripts then provided the universe of material for subsequent qualitative analysis. Results:- The results of this study demonstrated that approximately half of the children who had experienced a RTA were suffering from a post traumatic stress disorder (PTSD). In addition, the PTSD case children differed from the non-case children on factors such as awareness of the inpending RTA, feelings of self-blame regarding the accident, and more negative thoughts regarding their experience immediately after the impact and at the time of the assessment. In addition, the parents of the case children displayed similar responses to that of their children. Conclusion: - A theoretical Model was presented to account for the main findings in response to the research questions, also drawing on existing research. It is emphasised that this model is speculative due to the small sample size insofar as it draws upon the present findings, and as such can only relate to this study sample and further research would be required to fully test and validate it. In addition, recommendations were made for service delivery and clinical practice.

This study aimed to survey an adolescent sample for the prevalence of PTSD symptoms following a road traffic accident (RTA). In addition, it aimed to examine the relationship between PTSD symptoms and a number of variables which have been suggested by Rachman's (1980)emotional processing. theory to be important in the development of PTSD. Rachman's theory suggests that intrusive phenomena are indicative of emotional processing. His theory accounts for both everyday and trauma related intrusive phenomena and suggests that the same mechanisms a; c employed in both everyday and traumatic processing. This study examined the influence of controllability and affective discomfort associated with everyday intrusive thoughts on the levels of PTSD seen in adolescents involved in RTAs. In addition, other variables were assessed which were Suggested by Rachman to be indicative of successful emotional processing (e. g. social support). 34 4'r, adolescents between the age of 10 and 16, who had been involved in RTAs were asked to complete" battery of questionnaires presented in a structured interview format. Each participant completed the Impact of Events Scale (Horowitz et al., 1979), the Revised Children's Manifest Anxiety Scale Reynolds and Richmond, 1978), the Birleson depression inventory (Birleson, 1981), the Crisis Support Scale (Joseph et al., 1992) and two measures of accident related intrusive thoughts and everyday intrusive thoughts which have been adapted from previously used instruments (Salkovskis, l 985, Allsopp and Williams, 1996). A quarter of all adolescents involved in RTAs were found to Stiffer severe levels of PTSD psychopathology as measured by the IES. The experience of accident related intrusive thoughts was associated with higher levels of PTSD symptoms. Everyday 4ioughts, that were controllable and did not cause affective discomfort, were associated with lower levels of PTSD symptoms. Post-traumatic symptoms were predicted by accident severity variables such as collision speeds and degree of injury. Variables suggested by Rachman (e. g. controllability %f intrusive thoughts) were found to supplement accident severity variables. While considering the methodological problems encountered, the results of this study are discussed along with their implications for clinical practice and future research.

Worldwide, fatal traffic injuries and drowning deaths are important problems. The aim of this thesis was to investigate the cirumstances of fatal and non-fatal traffic injuries and drowning deaths in Sweden including analysis of the presence of alcohol and drugs, which are considered to be major risk factors for these events. Data where obtained from the database of National Board of Forensic Medicine. In the first study, we investigated 420 passenger deaths from 372 crashes during 1993-1996. There were 594 drivers involved. In total, 21% of the drivers at fault were alcohol positive compared to 2% of drivers not at fault (p<0.001) (Paper I). During 2004-2007, crashes involving 56 fatally and 144 non-fatally injured drivers were investigated in a prospective study from Northern Sweden (Paper II). The drivers were alcohol positive in 38% and 21%, respectively. Psychoactive drugs were found in 7% and 13%, respectively. Benzodiazepines, opiates and antidepressants were the most frequent drugs found in drivers. Illict drugs were found 9% and 4% respectively, with tetrahydrocannabinol being the most frequent of these drugs (Paper II). We investigated 5,125 drowning deaths in Sweden during 1992-2009 (Paper III). The incidence decreased on average by about 2% each year (p<0.001). Unintentional drowning was most common (50%). Alcohol was found in 44% of unintentional, 24% of intentional, and 45% of undetermined drowning deaths. Psychoactive substances were detected in 40% and benzodiazepines were the most common substance. Illicit drugs were detected in 10%. Of all drowning deaths, a significantly higher proportion females commited suicide compared with males (55% vs. 21%, p<0.001). Suicidal drowning deaths (n=129) in Northern Sweden were studied further in detail (Paper IV). of these, 53% had been hospitalized due to a psychiatric diagnosis within five years prior to the suicide. Affective and psychotic disorders were the most common psychiatric diagnoses. Almost one third had performed a previous suicide attempt. One fourth had committed suicide after less than one week of discharge from hospital. Alochol was found in 16% and psychoactive drugs in 62% of these cases, respectively.  In conclusion, alcohol and psychoactive drugs are commonly detected among injured drivers and drowning victims, and probably play a role in these events. Most of the individuals that tested positive for alcohol and high blood concentrations, indicating alochol dependence or abuse. This association warrants futher attention when planning future prevention.

This thesis explored the epidemiology of Posttraumatic Stress Disorder (PTSD) and different aspects of the disorder. Firstly, we investigated the lifetime prevalence of traumatic experiences and PTSD in the general adult population in Sweden and evaluated the impact of different trauma types, trauma frequency, and perceived distress. The results show that traumatic experiences are common and PTSD is not rare; roughly one out of ten traumatic events results in PTSD, with a 5.6% lifetime prevalence. The female/male ratio is 2:1. The risk for PTSD increases considerably with a high trauma-associated emotional impact. The distressing impact of a given trauma appears to be higher in women than in men, indicating an increased vulnerability in women. Secondly, we hypothesized that traffic road accidents (TRA’s) are one of the most prevalent types of traumatic events in Swedish society; therefore, we examined the impact of event and response characteristics associated with TRA’s on PTSD development. The data demonstrate that of those who had experienced a TRA (n=1074, 58.9%), 6.1% reported lifetime PTSD. TRA’s associated with fatal accidents and injury to oneself and related to high distress more than double the risk for PTSD. Thirdly, we compared the relative merits of the DSM-IV’s three-factor solution for PTSD symptoms to alternative models. We found that the symptomatology is equally well accounted for using all factor analytic models as yet presented in the literature; the DSM-IV, we found, provides as good a fit to data as other models. Fourthly, we examined the neurofunctional correlates of PTSD symptoms and whether a treatment-induced (serotonin reuptake inhibitor - SSRI) reduction of PTSD symptoms is associated with altered rCBF during symptom provocation. Our results indicate that PTSD symptoms correlates with areas involved in memory, emotion, attention, and motor control and that SSRI treatment normalizes provocation-induced rCBF in these areas.

Transportation-related collisions are ubiquitous and often traumatic. Identifying post-collision psychological distress and the characteristics of the collision survivor that lead to distress are vital to the development of early and appropriate interventions. The goals of this study were: 1) to use a questionnaire as opposed to a typical diagnostic interview, 2) to confirm that psychological distress is present in currently hospitalized transportation-related collision survivors, 3) to confirm that different types of distress co-occur, 4) to determine if distress is more likely to occur in those who have had prior distress, and 5) to explore the relationship between symptoms of distress and perception of control by self, others, and God/Higher Power of past, present, and future collision-related events. Subjects were 100 English speaking adult inpatients, 16 years and older, who were less than 3 weeks post-injury, and receiving some rehabilitation. Participants completed a questionnaire which included the Center for Epidemiologic Studies Depression Scale (CES-D), Beck Anxiety Inventory (BAI), and Davidson Trauma Scale (DTS) as well as questions regarding demographics, details of the collision/injury, alcohol/drug use, pain, past and present stressors, social support, and perceptions of life change. Information about head injury and collision-concurrent alcohol and/or drug use was collected from the patient's medical chart. Compared to other traumatic experiences (e.g., physical/sexual abuse, war combat), transportation-related collisions share the characteristics of being sudden, unexpected, relatively brief in duration, and potentially lethal. Prior studies used diagnostic interviews to identify psychological distress in post hospitalized collision survivors. This study used questionnaire-based depression, anxiety, and trauma symptom inventories in a currently hospitalized sample and included head injured patients. As hypothesized there was a significant correlation between the CES-D total score and the BAI total score [Hypothesis 1], the DTS total score [Hypothesis 2], and collision concurrent alcohol and/or drug use (as indicated by medical chart records or score on the CAGE) [Hypothesis 3]. Further, there was a significant correlation between the patient's self-reported history of depression, anxiety, or stress reaction and CES-D, BAI, and DTS total scores, respectively [Hypothesis 4]. Also as hypothesized, perceived personal control of the past "events that caused the collision" was significantly correlated with the CES-D total score [Hypothesis 5] while perceived control of the present "life in general right now" was negatively correlated to the CES-D total score [Hypothesis 6]. Contrary to hypothesis, perceived control of the present "recovery process right now" was not correlated to the CES-D total score [Hypothesis 6] nor was perceived control of the future "preventing a collision like this from happening...again" [Hypothesis 7]. Perception of control by "others" of the present "recovery process right now" was negatively correlated to the CES-D total score. Results support the theory that perceived personal control of past traumatic events increases the likelihood of psychological distress. Some evidence of post traumatic growth was found.

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O objetivo do estudo foi identificar a prevalência e os fatores associados às alterações da comunicação nas vítimas de acidente de transporte terrestre, no momento do atendimento pré-hospitalar no município do Recife. Trata-se de um estudo seccional, onde foram analisados os prontuários das vítimas de acidentes de transporte terrestre atendidas pelo SAMU-Recife, entre junho/2013 e julho/2014. Foram calculadas as prevalências das variáveis dependentes. O Teste Qui-Quadrado e o Teste Exato de Fisher selecionaram as variáveis associadas ao desfecho, considerado significante p < 0,05. Para a seleção das variáveis para a análise multivariada, foi considerada significância ≤ 0,20. Como resultados, foram elaborados dois artigos: uma revisão sistemática como parte da fundamentação teórica e um artigo original que estudou 4.298 vítimas, a maioria homens (75,3%) entre 20 a 29 anos (58%). Foram identificadas as prevalências para ausência de resposta verbal e dificuldade de fala de 4,11% e 3,14%, respectivamente. Observadas associação de ausência de resposta verbal e dificuldade de fala em motociclistas e ciclistas, que não usavam capacete, com agitação psicomotora, lesões de face, dispneia, obstrução de vias aéreas e que ingeriram bebida alcóolica. A medida da prevalência das alterações da comunicação em vítimas de acidente de transporte terrestre e os fatores associados encontrados foram considerados relevantes por ser, até então, desconhecidos pela comunidade científica, sendo necessário que os serviços de atendimento pré-hospitalar, hospitalar e de reabilitação estejam preparados para avaliar e atender essas vítimas.
The objective of the study was to identify the prevalence and factors associated with the communication changes in land transport accident victims at the time of pre-hospital care in the city of Recife. This is a cross-sectional study, which analyzed the medical records of victims of road accidents attended by the SAMU-Recife, between June / 2013 and July / 2014. The prevalence of the dependent variables was calculated. The chi-square test and Fisher's exact test selected variables associated with the outcome, considered significant p <0.05. For the selection of variables for multivariate analysis, significance was ≤ 0.20. As a result, two articles were prepared: a systematic review as part of the theoretical foundation and an original article that studied 4.298 victims, mostly men (75.3%) between 20 to 29 years (58%). Prevalence were identified for lack of verbal response and speech difficulties of 4,11% and 3,14% respectively. Observed association of lack of verbal response and speech difficulties for motorcyclists and cyclists who wore no helmet, with psychomotor agitation, face injuries, dyspnea, airway obstruction and drank alcoholic beverages. As the prevalence of communication changes in land transport accident victims and the associated factors were considered relevant by being hitherto unknown to the scientific community, it is necessary that the pre-hospital care, hospital and rehabilitation services are prepared to assess and address these victims.

This study examined chronic psychological and psychophysiological post-traumatic sequelae among eleven adolescent survivors of a fatal bus crash by means of a multimethod strategy. Measures included a structured DSM-m-R post-traumatic stress disorder (PTSD) interview using the Diagnostic Interview for Children and AdolescentsRevised (DICA-R), self-report measures of PTSD symptoms with the Reaction Index, and the Impact of Events Scale. Other measures of stress-related symptomatology included the State-Trait Anxiety Inventory, Fear Survey Schedule-IT, Anxiety Sensitivity Index, Anxiety Frequency Index, and Beck Depression Inventory. In addition, heart rate (HR) reactivity to mental arithmetic (MA), demographic questions, and crash questions was assessed. Survivors were compared to control subjects matched for age, gender, race, and socioeconomic status, among other demographic characteristics. Multivariate analyses of the psychiatric interview data indicated that survivors evidenced significantly higher levels of past PTSD symptoms experienced after the crash, with a significant group by gender interaction, F (3,17) = 5.22, P = .01. Current (past month) levels of PTSD symptoms were also significantly higher among survivors four years after the crash, F (3,17) = 8.82, P < .01, although PTSD symptomatology decreased overall during that time, F (3,17) = 15.52, P < .01. Survivors and controls did not differ significantly on other measures of PTSD and other stress-related symptomatology. Repeated measures analyses of HR response scores revealed greater HR reactivity to questions about the crash among survivors, F (1, 14) = 18.55, P < .01, and by gender, F (1, 14) = 5.21, P = .04. Similar analyses found greater variability in survivors' HR standard deviations (an index of autonomic lability) F (1,14) = 5.21, P = .03 in response to the crash interview. Survivors' HR did not differ from controls' on the MA task. Findings are discussed theoretically and methodologically within the contexts of neurological and conditioning models of PTSD. No relationship between HR reactivity and psychiatric symptomatology was found. Furthermore, this investigation did not fmd support for the neurological kindling theory. Areas of future research using psychophysiological assessment are proposed to more specifically elicit autonomic arousal. Detailed case studies of four individual response patterns are included as a heuristic for further physiological research and for clinical applications with adolescent trauma victims.
Ph. D.

Le cerveau contient environ cent milliards de cellules nerveuses, ou neurones. Ces neurones communiquent entre eux par des structures fonctionnellement distinctes – l’axone et la dendrite – capables d’émettre et recevoir des signaux électriques ou chimiques à partir d’un compartiment présynaptique vers un compartiment, dit post-synaptique. Nous avons focalisé notre étude sur les synapses des neurones hippocampiques, qu’on estime responsables de fonctions cérébrales dites supérieures, comme la mémoire et l’apprentissage. Plus particulièrement, on s’est intéressé au développement et au maintien des épines dendritiques, dont les changements morphologiques sont intimement liés à la plasticité synaptique, autrement dit, capacité de réponse à l’activité synaptique. Les épines dendritiques ont pour origine les filopodes qui évoluent en épines lors du contact axonal. La transition entre filopode et épine implique une myriade de molécules, dont des récepteurs glutamatergiques, des protéines d’échafaudage et du cytosquelette d’actine capables de recevoir, transmettre et intégrer le signal présynaptique. Cependant, la coordination spatiale et temporelle de tous ces composants moléculaires au long de la formation et maturation d’une synapse reste largement méconnue.Scribble1 (Scrib1) est une protéine de polarité cellulaire (PCP) classiquement impliquée dans l’homéostasie de tissues épithéliaux ainsi que dans la croissance et progression des tumeurs. Scrib1 est aussi une protéine d’échafaudage critique pour le développement et le bon fonctionnement du cerveau. L’objectif de cette étude a donc été d’étudier les mécanismes moléculaires sous-jacents à un rôle potentiel de Scrib1 dans la formation et le maintien des synapses. Dans un premier temps, on a décrit l’importance d’interactions dépendantes des domaines PDZ sur le trafic des récepteurs glutamatergiques ainsi que sur la voie de signalisation de plasticité synaptique sous-jacente à la mémoire spatiale. Dans un second temps, nous avons évalué les conséquences fonctionnelles d’une mutation de Scrib1 récemment identifiée chez un patient humain atteint des troubles du spectre autistique (TSA) dans la morphologie et fonction des neurones. On a démontré que Scrib1 régule l’arborisation dendritique ainsi que la formation et le maintien fonctionnel des épines dendritiques via un mécanisme dépendent du cytosquelette d’actine. Le dérèglement de ces mécanismes pourrait être à l’origine du phénotype TSA. L’ensemble de ce travail met en évidence que Scrib1, protéine d’échafaudage clé dans le développement et la fonction du cerveau, joue une multitude de rôle du niveau subcellulaire au niveau cognitif
The brain is made up of billions of nerve cells, or neurons. Neurons communicate with each other through functionally distinct structures - the axon and the dendrite - which are able to release and receive an electrical or chemical signal from a pre- to a post-synaptic compartment, respectively. We focused our study on hippocampal neurons synapses, which ultimately underlie high-order brain functions, such as learning and memory. In particular, we studied the development and maintenance of dendritic spines, whose changes in morphology are intimately correlated with synaptic plasticity, or the ability to respond to synaptic activity. Dendritic spines originate from motile dendritic filopodia, which mature into spines following axonal contact. The filopodia-to-spine transition involves a plethora of molecular actors, including glutamate receptors, scaffold proteins and the actin cytoskeleton, able to receive, transmit and integrate the pre-synaptic signal. The spatial and temporal coordination of all these molecular components throughout the formation and maturation of a synapse remains, however, unclear. Scribble1 (Scrib1) is planar cell polarity protein (PCP) classically implicated in the homeostasis of epithelial tissues and tumour growth. In the mammalian brain, Scrib1 is a critical scaffold protein in brain development and function. The main goal of this work was, therefore, to investigate the molecular mechanisms underlying Scrib1 role in synapse formation and maintenance. In a first part, we depict the importance of Scrib1 PDZ-dependent interactions on glutamate receptors trafficking as well as bidirectional plasticity signalling pathway underying spatial memory. In a second part, we focus on the functional consequences of a recently identified autism spectrum disorder (ASD) mutation of Scrib1 on neuronal morpholgy and function. We demonstrated that Scrib1 regulates dendritic arborization as well as spine formation and functional maintenance via an actin-dependent mechanism, whose disruption might underlie the ASD phenotype. Taken altogether, this thesis highlights the PCP protein Scrib1 as key scaffold protein in brain development and function, playing a plethora of roles from the subcelular to the cognitive level

Os acidentes de trânsito constituem a 13ª causa mais freqüente de morte no Brasil, ocupando o primeiro lugar na faixa de 10 a 14 anos, e o segundo na faixa dos 15 aos 29 anos. Estudos indicam que do total do custo dos acidentes de trânsito, mais de 20% deve-se diretamente ao uso indevido de álcool. Estudos internacionais que relacionam o consumo de álcool com fatalidades no trânsito são freqüentes, mas carecemos de dados epidemiológicos confiáveis e de abrangência nacional que sinalizem a atual e real situação. Portanto, o objetivo do presente estudo é realizar uma análise retrospectiva de dados de vítimas fatais de acidentes de trânsito ocorridos no Município de São Paulo no ano de 2005, para estabelecer a relação do uso do álcool e a morte no trânsito. Nas 907 vítimas avaliadas, notou-se uma associação com o uso de etanol, com 39,4% de casos positivos. Para condutores de veículos, essa porcentagem atinge 55,8%, todos acima do limite máximo permitido para condução à época, de 0,6 g/l. Acidentes em geral, e aqueles relacionados ao álcool, ocorreram com maior frequência aos sábados e domingos, e nos horários das 18hs às 6hs da manhã Os resultados demonstram uma associação do etanol com a ocorrência de vítimas fatais, e devem servir como alerta para o desenvolvimento de políticas públicas visando diminuir este grave problema.
Traffic accidents, in Brazil, account for the 13th most frequent cause of death, being the 1st most frequent among 10 to 14 year olds, and second for those aged 15 to 29. Studies indicate that form the total cost of traffic accidents, over 20% are directly due to the harmful consumption of alcohol. International studies that relate alcohol consumption to traffic fatalities are frequent, but we lack nationwide epidemiological data that present the current and real situation. Thus, the objective of the present study is to carry out a retrospective analysis of data from fatal traffic accident victims, in the city of Sao Paulo, in the year 2005, to establish the relationship between alcohol consumption and traffic deaths. In the 907 evaluated victims, an association with ethanol use was found, with 39.4% of cases being positive. For automobile drivers, this percentage reached 55.8%, all of them above the maximum level allowed at the time, 0.6 g/l. Accidents in general, and those related to alcohol happened in greater frequency on Saturdays and Sunday, and from 6PM to 6AM. The results show an association of alcohol consumption with fatal victims in traffic accidents, and should be a cause for concern. The data present can help in implementing and developing public policies aiming to diminish this grave issue.

Jeder Vierte erleidet im Laufe seines Lebens einen Verkehrsunfall. Obwohl psychische Folgen verbreitet und vielfältig sind, bleiben sie oft unbeachtet oder ihnen wird erst Aufmerksamkeit zuteil, wenn wenn das Leiden oder die Beeinträchtigung durch sie zu stark werden oder die Symptomatik sich längst chronifiziert hat. Am Lehrstuhl für Klinische Psychologie und Psychotherapie der TU Dresden wurde in Zusammenarbeit mit der Christoph-Dornier-Stiftung für Klinische Psychologie in Dresden ein Forschungsprojekt zu psychischer Traumatisierung nach Verkehrsunfällen durchgeführt. Schwerpunkt dieser Studie war es, herauszufinden, inwieweit psychische Beeinträchtigungen wenige Tage nach einem Verkehrsunfall sowie 3 und 6 Monate danach auftreten und welche auslösenden bzw. aufrechterhaltenden Faktoren für die psychischen Beeinträchtigungen zu finden sind. Zu diesem Zweck wurden in einer Unfallklinik Patienten mit einer Fragebogenbatterie untersucht, die dort nach einem Verkehrsunfall eingeliefert worden waren. Die Auftretenshäufigkeit von posttraumatischer Belastungssymptomatik steigt über den Untersuchungszeitraum hinweg leicht an, dies gilt sowohl für klinische als auch subklinische Symptomatik. Interessant sind hier v.a. die verschiedenen Verlaufstypen. Die Gedanken-kontrollstrategien &quot;Ablenkung&quot; und &quot;Sorgen&quot; scheinen beim Umgang mit auftretenden Intrusionen eine relevante Rolle im Zusammenhang mit der posttraumatischen Belastungssymptomatik spielen. Weiterhin zeigte sich, daß Variablen wie die subjektiv wahrgenommene Kontrollierbarkeit der Unfallsituation oder die Beschäftigung mit der Frage &quot;Warum gerade ich?&quot; Einfluß auf die Entwicklung posttraumatischer Symptomatik ausüben. Die Ergebnisse der Studie haben mehrere Implikationen: Erstens konnte repliziert werden, daß posttraumatische Belastungssymptomatik nach Verkehrsunfällen ein relevantes Problem ist, das nicht einfach ignoriert werden darf. Zweitens konnten Erkenntnisse über den längsschnittlichen Verlauf der Symptomatik bereitgestellt werden, die eine Früherkennung von potentiellen Betroffenen näher rücken läßt. Drittens und letztens konnte die wichtige Rolle der kognitiven Variablen bei der Entstehung einer Posttraumatischen Belastungsstörung nach Verkehrsunfällen untermauert werden.

Jeder Vierte erleidet im Laufe seines Lebens einen Verkehrsunfall. Obwohl psychische Folgen verbreitet und vielfältig sind, bleiben sie oft unbeachtet oder ihnen wird erst Aufmerksamkeit zuteil, wenn wenn das Leiden oder die Beeinträchtigung durch sie zu stark werden oder die Symptomatik sich längst chronifiziert hat. Am Lehrstuhl für Klinische Psychologie und Psychotherapie der TU Dresden wurde in Zusammenarbeit mit der Christoph-Dornier-Stiftung für Klinische Psychologie in Dresden ein Forschungsprojekt zu psychischer Traumatisierung nach Verkehrsunfällen durchgeführt. Schwerpunkt dieser Studie war es, herauszufinden, inwieweit psychische Beeinträchtigungen wenige Tage nach einem Verkehrsunfall sowie 3 und 6 Monate danach auftreten und welche auslösenden bzw. aufrechterhaltenden Faktoren für die psychischen Beeinträchtigungen zu finden sind. Zu diesem Zweck wurden in einer Unfallklinik Patienten mit einer Fragebogenbatterie untersucht, die dort nach einem Verkehrsunfall eingeliefert worden waren. Die Auftretenshäufigkeit von posttraumatischer Belastungssymptomatik steigt über den Untersuchungszeitraum hinweg leicht an, dies gilt sowohl für klinische als auch subklinische Symptomatik. Interessant sind hier v.a. die verschiedenen Verlaufstypen. Die Gedanken-kontrollstrategien &quot;Ablenkung&quot; und &quot;Sorgen&quot; scheinen beim Umgang mit auftretenden Intrusionen eine relevante Rolle im Zusammenhang mit der posttraumatischen Belastungssymptomatik spielen. Weiterhin zeigte sich, daß Variablen wie die subjektiv wahrgenommene Kontrollierbarkeit der Unfallsituation oder die Beschäftigung mit der Frage &quot;Warum gerade ich?&quot; Einfluß auf die Entwicklung posttraumatischer Symptomatik ausüben. Die Ergebnisse der Studie haben mehrere Implikationen: Erstens konnte repliziert werden, daß posttraumatische Belastungssymptomatik nach Verkehrsunfällen ein relevantes Problem ist, das nicht einfach ignoriert werden darf. Zweitens konnten Erkenntnisse über den längsschnittlichen Verlauf der Symptomatik bereitgestellt werden, die eine Früherkennung von potentiellen Betroffenen näher rücken läßt. Drittens und letztens konnte die wichtige Rolle der kognitiven Variablen bei der Entstehung einer Posttraumatischen Belastungsstörung nach Verkehrsunfällen untermauert werden.

INTRODUÇÃO O consumo de álcool combinado com bebidas energéticas (AmED) tem se mostrado associado tanto a um padrão pesado de ingestão de bebidas alcoólicas, quanto a comportamentos de risco no trânsito (CRTs) entre jovens adultos. Devido ao grave impacto causado pelas incapacidades e mortes no trânsito serem decorrentes de comportamentos previsíveis e em grande parte evitáveis, o presente estudo procura investigar a influência do consumo de AmED sobre os comportamentos de risco no trânsito entre os motoristas de caminhão. MÉTODOS Dados de uma amostra de profissionais que trafegavam pelas rodovias do Estado de São Paulo entre junho de 2012 e setembro de 2013 (N=535) foram separados em três grupos: (a) os que afirmaram ingerir AmED (n=90), (b) que relataram consumir apenas bebidas alcoólicas (n=326) e (c) o restante da amostra (n=445). Análises bivariadas foram realizadas com os relatos positivos nos últimos 12 meses que antecederam a pesquisa. O nível de significância foi estipulado para um alfa de 5% e, posteriormente, a analise múltipla utilizou a regressão logística. RESULTADOS Comparando os condutores que ingeriram AmED com os que consumiram apenas bebidas alcoólicas, os primeiros tiveram mais chances de possuir idades entre 20 e 24 anos (OR=3,3), de trabalhar como profissional a menos de 5 anos (OR=2,5), apresentaram maiores riscos de dirigir sem cinto de segurança (OR=2,2), em alta velocidade (OR=1,9), ter brigado ou discutido no trânsito (OR=2,1), ter consumido bebidas alcoólicas em um padrão pesado (OR=3,4), bebendo mais doses alcoólicas por ocasião (mediana 5 vs 2 doses, p < 0,008); em maior frequência (OR=1,9), bebendo mais frequentemente no padrão binge drinking (OR=2,3) e consumindo drogas ilícitas em maior frequência (OR=2,3), além de maiores chances de apresentar uma qualidade de sono ruim (OR=1,7). Comparados ao restante da amostra, observou-se que os motoristas de caminhão que ingeriram AmED apresentaram maior risco de dirigir sem cinto de segurança (OR=2,2), em alta velocidade (OR=1,9), alcoolizado (OR=2,6), de brigar ou discutir no trânsito (OR=2,0), apresentaram maiores chances de ingerir mais doses alcoólicas por ocasião (medianas 5 vs 2 doses, p < 0,001), beber mais frequentemente (OR=2,6), inclusive no padrão binge drinking (OR=2,1), também em maior frequência em binge drinking (OR=3,2), consumir álcool em um padrão pesado (OR=3,4) e usar drogas ilícitas (OR=2,6). A regressão logística ajustada por idade indicou que os motoristas que brigaram ou discutiram no trânsito (OR=2,2), que dirigiram sem cinto de segurança (OR=1,9) e que relataram o uso de drogas ilícitas nos últimos 12 meses (OR=2,0) tiveram maiores chances de ter ingerido AmED. CONCLUSÃO O estudo indica uma associação entre a ingestão conjunta de álcool com bebidas energéticas e maiores chances de apresentar CRTs. São necessários investimentos em pesquisas e ações preventivas voltadas para essa população
INTRODUCTION: Consumption of alcohol mixed with energy drinks (AmED) has been shown associated with both a heavy pattern of alcohol intake as well as the traffic risk behaviors (TRB) among young adults. Due to the serious impact caused by disabilities and traffic deaths arising from predictable and largely preventable behaviors, the present study investigates the influence of AmED consumption on traffic risk behaviors among truck drivers. METHODS: Data from a sample of professional driving along the highways of the State of São Paulo (Brazil) between June 2012 and September 2013 (N=535) were divided into three groups: (a) those who reported drinking AmED (n=90), (b) who reported consuming alcohol only (n=326) and (c) the rest of the sample (n=445). Bivariate analyzes were performed with positive reports in the last 12 months preceding the survey. The level of significance was set for an alpha of 5% and, subsequently, it was made a multiple logistic regression analysis. RESULTS: Comparing the drivers who drink AmED with those who consumed only alcohol, the first were more likely to have between 20 and 24 years (OR=3.3), to work as a professional less than five years (OR=2.5), had higher risks of driving without a seat belt (OR=2.2), in high speed (OR=1.9), have a fight or discussion in traffic (OR=2.1), having consumed alcohol in a heavy pattern (OR=3.4), drinking more alcoholic drinks per occasion (median 5 vs 2 doses, p < 0.008); at higher frequency (OR=1.9), more often in binge drinking (OR=2.3), consuming illicit drugs more frequently (OR=2.3), as well as more likely to have a bad quality sleep (OR=1.7). Compared to the rest of the sample, it was found that truck drivers who drink AmED had higher risk of driving without a seat belt (OR=2.2), in high speed (OR=1.9), drunk (OR=2 , 6), to fight or discuss in traffic (OR=2.0), were more likely to consume more alcoholic drinks per occasion (median 5 vs 2 doses, p < 0.001), drinking more often (OR=2.6), including in binge drinking (OR=2.1), also in higher frequency in binge drinking (OR=3.2), consuming alcohol in a heavy pattern (OR=3.4) and use illicit drugs (OR=2 6). Logistic regression adjusted for age indicated that drivers who fought or discussed in traffic (OR = 2.2), which drove without a seat belt (OR = 1.9) and that reported using illicit drugs in the last 12 months (OR = 2.0) had higher chances of having ingested AmED. CONCLUSION: This study indicates an association between the combined intake of alcohol with energy drinks and more likely to have TRBs. Investment is needed in research and preventive actions for this population

Les circuits neuronaux régissent les comportements tels que la coordination motrice ou la mémoire et l’apprentissage. Au sein d’un réseau, les neurones communiquent par des processus moléculaires et cellulaires finement réglés à la synapse. Un des mécanismes régulant l’homéostasie synaptique, le transport de vésicules dans les neurones, est dérégulé dans les maladies neurologiques telles que le syndrome de Rett, la maladie d’Alzheimer et la maladie d’Huntington. Ainsi, investiguer la régulation du transport de vésicules dans les neurites dans un contexte physiologique est important pour comprendre, et potentiellement rétablir, les conséquences de ces dérégulations pathologiques.La protéine Huntingtine (HTT), connue pour son implication dans la maladie d’Huntington, est un acteur clé du transport axonal. Elle promeut et influence le transport des vésicules en favorisant le recrutement des adaptateurs et des moteurs moléculaires. Sa phosphorylation sur la sérine 421 (pHTTS421) régule la directionnalité des vésicules de BDNF, d’APP et de VAMP-7 dans des neurones transfectés in vitro. Cependant, les mécanismes et les conséquences de la régulation du transport par HTT comme la spécificité neuritique et les conséquences comportementales restent peu connus. Enfin, nous ignorons si la régulation du transport peut être influencée dans des conditions pathologiques afin de restaurer les phénotypes in vivo.Ce projet de thèse vise à caractériser les mécanismes et les conséquences de la régulation du transport axonal de trois types de vésicules par pHTTS421 et d’investiguer sa propension à restaurer les phénotypes associés à des maladies neurologiques dans des modèles de souris.Dans le but de reproduire in vitro les réseaux associés à des maladies neurologiques, nous avons utilisé des chambres microfluidiques. Nous avons étudié le transport des vésicules d’APP, des précurseurs des vésicules synaptiques (PVSs) ou des vésicules à cœur dense (VCDs) contenant BDNF au sein d’un réseau neuronal dans lequel pHTTS421 a été modifiée. Ces neurones sont issus de souris pour lesquelles la sérine 421 a été remplacée par un acide aspartique ou par une alanine pour mimer respectivement l’état phosphorylé (HTTS421D) ou non phosphorylable (HTTS421A) de la HTT.Dans la maladie d’Alzheimer, l’homéostasie d’APP est dérégulée. Nous avons donc étudié son transport et son accumulation synaptique dans un circuit corticocortical. Nous avons trouvé que la phosphorylation de la sérine S421 par Akt régule la directionnalité des vésicules d’APP uniquement dans les axones : HTTS421A diminue le flux antérograde axonal d’APP ainsi que ses niveaux à la synapse in vitro et in vivo. Réduire le flux antérograde d’APP dans un modèle murin d’Alzheimer restaure l’homéostasie synaptique in vivo et les déficits de mémoire associés (publication 1 ; Bruyère*, Abada*, Vitet* et al., eLife, 2020).Le transport axonal des PVSs régule le nombre de vésicules synaptiques (VSs), ce qui, dans un réseau corticostriatal, est essentiel à l’apprentissage de compétences motrices. Nous avons montré que pHTTS421 augmente le recrutement de la kinésine KIF1A sur les PVSs, augmentant le transport antérograde et la probabilité d’exocytose. En réduisant les niveaux de KIF1A dans le réseau corticostriatal des souris HTTS421D, nous avons trouvé que pHTTS421 augmente le nombre de VSs et altère la mémoire procédurale. Cette étude décrit comment le transport axonal des PVSs impacte les phénotypes comportementaux (publication 2 ; vitet et al., in prep).Enfin, le transport de BDNF est dérégulé dans le réseau corticostriatal des jeunes filles atteintes du syndrome de Rett. Nous avons observé que l’expression endogène de pHTTS421 ou l’injection d’un composé inhibant la calcineurine (FK506) restaure le transport de BDNF dans un réseau corticostriatal, la communication neuronale et les symptômes associés chez les souris modèles du syndrome de Rett (Publication 3 ; Ehinger et al., Embo Mol Med, 2020)
Neuronal circuits are at the basis of behaviors such as motor coordination or learning and memory. As being part of a network, neurons communicate at synapses through finely tuned molecular and cellular processes. One key mechanism regulating synapse homeostasis involves transport of vesicles within axons and dendrites which is dysregulated in many neurological disorders such as Rett syndrome, Alzheimer’s (AD) and Huntington’s diseases (HD). Thus, deciphering the regulation of vesicular transport within neurites in physiological context is crucial to understand, and potentially restore, the consequences of these dysregulations in pathological contexts.Huntingtin (HTT) protein, known for its devastating role in HD when mutated, is a key actor of axonal transport. It promotes and regulates vesicular transport in neurites by scaffolding adaptors and molecular motors. Particularly, HTT phosphorylation status on S421 regulates the directionality of BDNF, APP and VAMP-7 vesicles within neurites in cultured and transfected neurons. However, several questions remain to be elucidated regarding the mechanisms and the consequences of this HTT-dependent regulation of axonal transport such as the neuritic specificity (axons or dendrites) and the behavioral consequences of such modifications. Finally, we do not know whether transport regulation can be influenced in pathological conditions to restore disease-associated phenotypes in vivo.This thesis aims at characterizing in vivo the mechanisms and the consequences of axonal transport regulation of three different vesicles through the phosphorylation of Huntingtin at S421 and to investigate its propensity to restore disease-associated phenotypes in mouse models of human neurological disorders.In order to reproduce in vitro the in vivo networks associated to neurological disorders we used microfluidic devices. We investigated the transport of Amyloid Precursor Protein (APP) vesicles, precursors of synaptic vesicles (SVPs) or dense-core vesicles (DCVs) in neurons in which the HTT phosphorylation status was modified. These neurons came from mice in which Serine 421 has been replaced by an aspartic acid to mimic the phosphorylated form of HTT (HTTS421D) or by an alanine to mimic the unphosphorylatable form of HTT (HTTS421A).Transport of APP vesicles is impaired in AD. We investigated APP transport and accumulation at synapses within a corticocortical circuit. We found that Akt-mediated HTT phosphorylation at S421 regulates the directionality of APP containing vesicles in axons but not in dendrites: the phospho-defective form of HTT decreases axonal anterograde flux of APP and reduces its levels at presynaptic zones both in vitro and in vivo. Reducing anterograde flux of APP in familial AD mouse model restored synapse homeostasis in vivo and memory deficits (Publication 21; Bruyere*, Abada*, Vitet* et al., eLife, 2020).SVP axonal transport regulates the number of SVs at the synapse, which, within a corticostriatal synapse, is essential for motor skill learning. We found that HTT phosphorylation increases the recruitment of the molecular motor KIF1A on SVPs, thus promoting anterograde transport and the probability of release. Silencing KIF1A in the corticostriatal network of HTTS421D mice, we found that pHTTS421 increases the number of SVs at the synapse and impairs procedural memory through a specific HTT-KIF1A dependent mechanism. This study defines a pathway by which axonal transport of SVP impact the behavioral phenotype. (Publication 2; Vitet et al, in prep)Finally, it has been shown that BDNF transport within DCVs is dysregulated in the corticostriatal network of Rett syndrome’s patients. We found that endogenous HTT phosphorylation at S421 or a chemical inhibitor of calcineurin (FK506) rescue BDNF transport in the corticostriatal network, neuronal communication, and behaviors of Rett Syndrome mice (Publication 3; Ehinger et al., Embo Mol Med,2020)

Introduktion: Buller definieras som oönskat ljud. Uppfattningen av ett oönskat ljud är mycket individuellt. Det som anses vara oljud för en person, kan upplevas som icke-oljud för en annan person. Buller anses dock generellt som störande ljud och är vanligtvis något som varje individ stöter på under sin vardag som exempelvis på arbetsplatsen, skolan, eller i hemmet. Buller anses vara den miljöstörning som berör flest människor i Sverige. Det är ett växande problem och flygtrafik anses vara en av de mest genomgripande utomhusljudkällorna. Bullerproblem som är förknippade med flygtrafik är koncentrerade i områden nära flygplatser, vilket kan påverka flera tusentals boendes hälsa. Flygtrafikbuller har länge varit ett folkhälsoproblem och många människor som är bosatta i närheten av en flygplats har utvecklat ett antal negativa hälsoeffekter av flygtrafikbuller Syfte: Att undersöka hur boende som är bosatta nära flygplatsen Linköping City Airport upplever och påverkas av flygtrafikbuller.  Metod: Studien har utförts som en enkätundersökning med en kvantitativ tvärsnittsdesign. Webbenkäten som har använts som mätinstrument har konstruerats för att besvara syftet. 292 vuxna individer (>18år), varav 158 män och 133 kvinnor, deltog i studien. Insamlad statistiska data har bearbetats och analyserats i SPSS. För att kunna besvara syftet har följande statistiska tester använts: chi2-test, spearmans-korrelationsanalys och logistisk regressionsanalys.   Resultat och konklusion: Boende som är bosatta i Tannefors visade överlag positiva upplevelser till flygtrafiken och var positivt inställda till flygplatsen. De boende som upplevde störningar minst varje vecka vissa delar av året upplevde att flygtrafikbuller medför svårigheter att utföra olika aktiviteter. Kvinnor i den yngsta åldersgruppen upplevde flygtrafikbuller som mer störande jämfört med män. Män hade en mer negativ inställning till flygplatsen jämfört med kvinnor. Boende som rapporterade sämre hälsotillstånd, sömnproblem och användande av öronproppar eller något annat hörselskydd för att kunna sova bättre, sämre sömnkvalitet, trötthet, obehagskänslor, ledsenhet och nedstämdhet, osällskaplighet och att man föredrar att vara ifred, irritation och vresighet, stress, lock eller tinnitus i öronen meddelade också ett större besvär för flygtrafikbuller.
Introduction: Aircraft noise is an example of unwanted sound. The perception of unwanted sound is very individual. What is considered noise by one person may be perceived as non-noise by someone else. However, noise is generally regarded as disturbing noise and is usually something that each individual encounters in their daily life, such as in the workplace, at school, or at home. Noise is considered to be the form of environmental disruption that affects the most people in Sweden. It is a growing problem, and air traffic is considered to be one of the most pervasive outdoor sound sources. Noise problems associated with air traffic are concentrated in areas close to airports, which can affect the health of thousands of residents. Air traffic noise has long been a public health problem, and many people living near an airport have developed a number of negative health effects due to air traffic noise. Purpose: To study how residents living near Linköping City Airport experience and are affected by air traffic noise.   Method: The study has been conducted as a questionnaire survey with a quantitative crosssectional design. The online survey that has been used as a measuring instrument has been designed to answer the purpose. 292 adult subjects (> 18 years), including 158 men and 133 women, participated in the study. Collected statistical data has been processed and analysed in SPSS. In order to answer the purpose, the following statistical tests have been used: chi2 test, Spearman’s correlation analysis and logistic regression analysis. Results and conclusion: Residents living in Tannefors generally had positive experiences from air traffic and were positive towards the airport. The residents who experienced disturbances at least every week during certain parts of the year felt that air traffic noise caused difficulties performing various activities. Women in the youngest age group experienced air traffic noise as more disturbing compared to men. Men had fewer negative attitudes towards the airport compared to women. Residents who reported poorer health conditions, sleep problems and the use of earplugs or other hearing protectors to be able to sleep better, poorer sleep quality, fatigue, discomfort, sadness and depressed mood, low morale, a desire to be left alone, irritation and grief, stress, clogged ear or tinnitus also started that air traffic noise was a major inconvenience.

Pod pojmom politraume se podrazumeva teška istovremena povreda najmanje dve regije tela sa anatomskom težinom povrede AIS koja je jednaka ili veća od tri kao i ukupna izračunata anatomska težina povreda izražena ISS zbirom mora da bude veća od 15. Cilj istraživanja je da se primenom upitnika (SF36, PTSD–testa i Glazgov skale ishoda) proceni kvalitet života između politraumatizovanih pacijenata sa prelomomima dugih kostiju i politraumatizovanih bez preloma duge kosti kao i da se uoče rani pokazatelji loše prognoze kvaliteta života nakon završetka lečenja. Istraživanje je prospektivnog karaktera i obuhvatilo je 202 politraumatizovana pacijenta koji su bili povređeni u periodu 2010-2014 godine i bili lečeni u Urgentnom Centu Kliničkog Centra Vojvodine. Od 202 politraumatizovana pacijenta na kontrolne preglede se odazvalo ukupno 72 pacijenta, 37 sa prelomima dugih kostiju - ispitivana grupa i 35 politraumatizovanih pacijenata bez preloma duge kosti koji su činili kontrolnu gupu. Godinu dana nakon završetka hospitalizacije svaki ispitanik je popunjavao upitnik( SF36, PTSD test i Glazgov skala ishoda ), načinjen je klinički pregled i standardna radiografija predela preloma duge kosti. Rezultati ukazuju da ukupni kvalitet života nakon završetka lečenja se ne razlikuje značajno između ispitivanih grupa, iako politraumatizovani sa prelomima dugih kostiju imaju niži kvalitet života, odnosno značajno lošije fizički funkcionišu i imaju značajno češće psihičke poremećaje (postraumatski stresni poremećaj, depresija) u odnosu na kontrolnu grupu. Tip preloma duge kosti nije uticao na krajnji kvalitet života politraumatizovanih, dok su oni sa dva i više preloma imali značajno lošiji kvalitet života. Na osnovu dobijenih rezultata konstatovali smo da veću šansu za bolji kvalitet života imaju pacijenti mlađi od 44 godine, ukoliko su inicjalno imali vrednost ISS skora manji od 30,5 bodova, vrednosti sistolnog i dijastolnog arterijskog pritiska u referentnim vrednostima, kao i broja eritrocita i trombocita, i ukoliko su primili manje od 4 jedinica transfuzije krvi u prva 24 časa.
The term of polytrauma means, a patient with multiple severe injuries in at least two regions of the body with anatomical severity of trauma AIS equal or greater than three and the total calculated weight anatomical injuries expressed by ISS score must be greater than 15. The aim of our study is early estimate of quality of life in polytrauma patients with multiple fractures of the long bones and polytrauma patients without fractures of long bones as well as to detect early indicators of poor prognosis of quality of life after treatment, using questionnaires (SF 36, PTSD test and Glasgow Outcome Scale). This was prospective study and included 202 polytrauma patients who were injured during the period 2010-2014 and were treated in the Emergency Center of Clinical Center of Vojvodina. From 202 polytrauma patients, on control examinations responded 72 patients, 37 with fractures of long bones - study group and 35 polytrauma patients without fractures of long bones and they were control group. One year after the end of hospitalization each patient filled out a questionnaire (SF36, PTSD test and Glasgow Outcome Scale), made a clinical examination and standard X-rays of long bone fractures. Our results indicate that the overall quality of life after treatment is not significantly different between the groups, although polytraumatized patients with fractures have a lower quality of life and significantly worse physical functioning and have significantly more mental disorders (post-traumatic stress disorder, depression) compared to the control group. Type of long bone fractures did not affect on the final quality of life, while those patients with two or more fractures had a significantly poorer quality of life. Based on these results we concluded that greater chance for a better quality of life have patients younger than 44 years, unless they had initially ISS score less than 30.5 points, systolic and diastolic blood pressure in the reference values as well as the number of red blood cells and platelets, and if they received less than 4 units of blood transfusions in the first 24 hours.

Driver behaviour models are widely used in the traffic engineering literature and practice. They are used for understanding drivers’ manoeuvring decisions in traffic streams. They also form the building blocks of microscopic traffic simulation tools, which are employed for traffic flow analysis and capacity estimation necessary for the design and operation of traffic facilities and evaluation of operational strategies. Most driver behaviour models in the literature assume homogeneous and orderly traffic conditions, characterised by homogeneity (i.e., only passenger cars comprise the traffic streams) and orderliness (i.e., vehicles move only in the longitudinal direction, except when changing lanes). Models developed with such assumptions cannot be applied to analyse heterogeneous, disorderly (HD) traffic conditions. This is because HD traffic streams, unlike homogeneous traffic streams, comprise a wide variety of vehicle classes with considerably different physical and operational characteristics. Moreover, driving in HD traffic streams is characterised by weaker lane discipline due to a greater extent of lateral movements than that in homogeneous traffic streams. This dissertation aims to formulate and apply driver behaviour models for HD traffic streams on uninterrupted traffic facilities while considering the following aspects – (1) the multi-vehicle anticipation (MVA) behaviour, where drivers’ manoeuvring decisions are influenced by multiple vehicles around them, as opposed to a single lead vehicle ahead, (2) the treatment of driver behaviour as a combination of different manoeuvring decisions, such as the decision of whether to accelerate, decelerate, or remain in same speed (represented by a discrete variable) and the decision of the extent of acceleration or deceleration (represented by continuous variables) – as opposed to a single, continuous variable representing all these facets of driver behaviour, (3) the incorporation of stochasticity due to the errors drivers make in perceiving the traffic environment, and (4) the consideration of drivers’ intentions (which are typically latent to the analyst) and two-dimensional movements of vehicles simultaneously while also incorporating MVA behaviour. Specifically, the following driver behaviour models are formulated and applied to understand driver behaviour in empirical trajectory datasets from Chennai (HD traffic) and California (homogeneous traffic): 1. The first model presented in this dissertation is an MVA-based discrete-continuous choice modelling framework to model vehicles’ longitudinal movements in HD traffic streams. In this model, driver behaviour at a given time instance is treated as a combination of (a) the driver’s choice of whether to accelerate, decelerate, or maintain a constant speed – represented by a discrete variable – and (b) the extent of acceleration or deceleration – represented by continuous variables. The discrete and continuous variables representing driver behaviour are modelled using a simultaneous econometric framework. The proposed model is used to examine driver behaviour in the HD traffic dataset from Chennai. The empirical analysis reveals the significance of the MVA effect on driver behaviour. Specifically, drivers consider the relative speeds and space gaps with respect to multiple vehicles within an influence zone around their vehicle. In addition, it is found that the influence of the traffic environment on drivers’ discrete choices (whether to accelerate, decelerate, or maintain a constant speed) is not the same as that on their choices of how much to accelerate or decelerate. 2. The second model is an extension of the above model to recognise the panel data nature of vehicle trajectory datasets typically used for estimating the parameters of driver behaviour models. This model recognises the role of vehicle- and driver-specific unobserved factors (latent to the analyst), such as aggressiveness that influence driving behaviour, and such influence persists across all observations of a vehicle. Doing so helps in reducing the confounding effects of unobserved factors when the proposed model is applied to different datasets to compare driving behaviour in different traffic streams. The panel data model is used to understand and compare longitudinal driving behaviour between the HD traffic dataset of Chennai and the homogeneous traffic dataset of California. The empirical analysis reveals the presence of MVA effect on driving behaviour in the homogeneous traffic setting, too. However, drivers in the HD traffic stream are influenced by more vehicles in their vicinity than those in the homogeneous traffic stream. 3. In the third model formulation, a mixed multinomial logit-based framework is developed to recognise stochasticity in driver behaviour models due to drivers’ errors in perceiving the traffic environment. For this model, an econometric analysis is undertaken to evaluate two different ways of specifying errors in variables in discrete choice models – additive errors and multiplicative errors. It is shown that the multiplicative specification of errors has a better behavioural basis and allows better identification of parameters representing variability due to drivers’ perception errors. An application of this model to the HD traffic dataset reveals different levels of variability due to errors in the perception of different traffic environment variables. It is found that drivers may pay greater attention to (which results in lower variability in) perceiving space gaps and relative speeds with respect to vehicles directly ahead of them than those not directly ahead. 4. The fourth and final model formulation is a two-dimensional, MVA, and multi-stimuli-based latent class framework to analyse motorcyclists’ two-dimensional movements in HD traffic streams. This formulation conjectures that drivers manage their cognitive load by dividing their driving decisions into two steps – (a) higher-level, strategic intentions (of whether to accelerate, decelerate, or maintain a constant speed and whether to steer to the left of, right of, or keep straight along the longitudinal direction), which are not fully observable from vehicle trajectories (hence latent to the analyst), and (b) lower-level, tactical decisions that can be observed in vehicle trajectories, such as the specific angle of movement and the specific extent of acceleration or deceleration executed. When applied to the HD traffic dataset of Chennai, the proposed model suggests that drivers’ higher-level intentions are more strongly influenced by the microscopic traffic environment variables than their lower-level decisions, perhaps because drivers invest a greater extent of cognitive resources for making higher-level intentions than that for lower-level decisions. Finally, a traffic simulator is developed to simulate traffic streams using the models developed in this dissertation. The simulation experiments using this simulator demonstrate that all the microscopic driver behaviour models developed in this dissertation reflect the typically observed macroscopic properties of vehicular traffic steams.

The groundwork for much of the existing traffic flow theory was laid in the 1950s and 1960s by researchers from developed economies like the United States. The car-following modelling approach, which is arguably the most popular type of microscopic traffic flow models, and the kinematic wave modelling approach, which is still the basis for much of the macroscopic traffic flow theory, were first introduced during this period. Because the object of this and much of the subsequent research it has spawned is the traffic of developed economies, the classical traffic flow theory deals almost exclusively with this specific kind of traffic: lane-disciplined with relatively homogeneous passenger car traffic. However, the traffic in many developing economies have a significant share of two and three-wheeler motorized vehicles and non-motorized vehicles with different static and dynamic characteristics, resulting in a fundamentally different traffic stream. Because of the differences in sizes and manoeuvrabilities, the vehicles in this traffic stream do not follow the lane-discipline. This kind of traffic has been described in the literature as “heterogeneous, disordered (HD)” or “mixed” traffic. These developing economies, mostly from Asia and Africa, are rapidly urbanizing and the need to deal with the challenge of traffic congestion is more urgent than ever. Given that these countries are already struggling to keep pace with the rising urban population for providing the necessary road infrastructure, it may be more effective to make the most efficient use of the existing infrastructure through the use of traffic management solutions like real-time traffic monitoring and signal control. As such solutions cannot be formulated using the traditional traffic flow theory, an alternative theory that explicitly considers the characteristics of the HD traffic is urgently needed. In the present study, HD traffic is characterised by the division of its component vehicle classes into car-following and gap-filling types. Flow-density relationships are derived for each vehicle type based on first principles. A new multiclass cell transmission model (CTM) is then proposed that can accommodate these vehicle classes of these two types, and its properties are analysed. This is followed by the development of a new node-based dynamic traffic assignment (DTA) framework embedded with a single class CTM satisfying the link-level first-in-first-out principle. Both the dynamic user equilibrium (DUE) and dynamic system optimum (DSO) problems are formulated within this framework as complementarity problems with guaranteed solution existence. Algorithms are developed to efficiently compute all the relevant travel costs and marginal costs needed in the determination of the DUE and DSO solutions. This DTA framework is then combined with the CTM for HD traffic proposed previously, followed by the extension of the DUE and DSO problem formulations and all the relevant algorithms to the context of HD traffic. Other contributions of this work include a comprehensive review of the studies conducted in the context of HD traffic, the proposal of a new methodology for the con- struction of driving cycles for cities with HD traffic, and the introduction of a backpropagation technique to efficiently compute the costs needed to calculate the DTA solutions.

Introduction: Little is known about the effect of beliefs on whiplash-associated disorders. Objective: To assess population beliefs regarding whiplash injury, to assess expectation as a predictor of recovery; to explore symptom attribution (Study III); and, assess the relationship between the Whiplash Disability Questionnaire (WDQ) and self-assessed recovery. Materials and Methods: Canadian residents were surveyed about whiplash injury; a whiplash cohort was assessed for association between expectations of recovery and recovery; whiplash patients were examined to correlate auditory symptoms and cerumen occlusion; and, Whiplash patients were asked a global recovery question and results compared to the whiplash Disability Questionnaire (WDQ). Results: Beliefs about whiplash injury were more negative. Expectations of recovery from injury increases the recovery rate. Cerumen explains auditory symptoms in whiplash patients. Patients responding yes to the recovery question had a low WDQ score. Conclusions: Population beliefs, expectations of recovery and symptom attribution are important in whiplash-associated disorders.
Experimental Medicine

Increased psychophysiological arousal in response to trauma cues is a symptom of Posttraumatic Stress Disorder (PTSD). Emotional and cognitive reactions to traumatic events are also symptoms of PTSD. Most commonly, research into increased arousal in particular has focused on the differences between reactions to trauma reminders of individuals with and without PTSD. However, relatively few studies have explicitly examined whether increased arousal as a consequence of a traumatic event can generalise to other situations post trauma. Further, the possibility of emotional and cognitive reactions to traumatic events generalising to other stressful life events has not been specifically examined. This investigation was concerned with identifying whether the increased arousal, emotional reactions and cognitive responses associated with posttraumatic stress reactions remain trauma specific or whether it is possible for these symptoms to generalise to other non-trauma related stressful events. Three groups were involved in this study including individuals who had developed PTSD as a result of a motor vehicle accident (MVA), a group who no longer met the diagnostic criteria for Acute Stress Disorder (ASD) and did not progress to PTSD as a result of a MVA, and a group of individuals who had been in a MVA but who had not developed psychological symptoms. An intensive design was employed with all individuals being involved in all studies. Four studies were conducted using this design strategy. Initially, participants' diagnoses were determined through the Clinician Administered PTSD Scale [CAPS] (Blake, Weathers, Nagy, Kaloupek, Charney, & Keane, 1998) and the Acute Stress Disorder Scale [ASDS] (Bryant, Moulds, & Guthrie, 2000). In Study One, self-report questionnaires were administered to determine demographic characteristics, MVA details and the possible influence of individual factors related to diagnoses. The PTSD group was older than the ASD or Control groups but no other demographic differences between the groups were apparent. The CAPS successfully discriminated the three diagnostic groups: PTSD, ASD and Control. As expected the PTSD and ASD groups reported more posttraumatic stress symptoms than did the Control group. The ASD group also had a greater tendency to dissociate in general and was associated with elevated levels of general symptomatology compared to the PTSD and Control groups. In respect to cognitive factors, ASD was again linked to increased endorsements of beliefs concerning approval, guilt and predetermination. However, both PTSD and ASD were associated with stronger beliefs related to fear than was the Control group. Study Two examined the psychophysiological response to the MVA and two stressful events, one from before the MVA and one post MVA, and a nonstressful event. The stressful events were either similar to the traumatic MVA or general life stressors unrelated to the traumatic MVA. A four stage guided imagery methodology was used to examine psychophysiological responses to these events. The responses of all diagnostic groups were similar with the MVA and stressful events eliciting greater arousal than did the non-stressful event. In Study Three, visual analogue scales (VASs) were administered to determine the emotional reactions of individuals to the traumatic, stressful and non-stressful events. Differences were also apparent between reactions to the trauma specific and generalised non-trauma related stressful events. Despite the lesser objective severity, reactions to the trauma specific stressful event occurring after the traumatic MVA were found to be identical to reactions to the traumatic MVA itself. However, in response to stressful events unrelated to the traumatic event, the emotional reactions reflected the nature of the events

This dissertation focuses on the field of psychosocial counselling intended for the people involved in traffic accidents. Traffic accidents often result in considerable whole-society damages and significant reduction in the life quality of affected individuals or their relatives. Traffic accidents may often represent nerve-racking, traumatic events which significantly go beyond the scope of common human experience. People involved in traffic accidents may suffer from mental problems which might impair an area of their social functioning. As a result, traffic accidents have significant impact not only to the lives of persons directly involved, but also to their relatives. Victims´ self-help may fail and, without the expert intervention, may lead to the whole-life misery. One of possible ways of how to help the people involved in the traffic accident is the psychosocial counselling which is the subject of this dissertation. This thesis, among others, aims to analyse the offer of psychosocial consulting services intended for traffic accident participants in the town of České Budějovice. To this end, the combination of qualitative and quantitative data collection techniques, questionnaire survey of experts and organizations and semi-standardized interviews with experts operating in České Budějovice were carried out. Other goals of the thesis included mapping of public awareness concerning the possible utilization of psychosocial counselling for traffic accident participants in České Budějovice, as well as, mapping the interest in using such services on the public{\crq}s part in this town. A public questionnaire survey was performed to reach these objectives. The findings revealed that there is a public demand for services of an organization providing the people involved in traffic accidents with psychosocial counselling. The public awareness of the possibility of using psychosocial counselling in this area, however, proved to be low in České Budějovice. The survey has also shown that the offer of psychosocial counselling focused on traffic accident participants does exist in this town. The dissertation may contribute to higher awareness of not only the professional employees who provide the assistance (psychologists, social workers, non-profit organization employees, physicians, police officers, fire fighters), students of humanities and volunteers involved in giving psychosocial assistance to the victims of disasters, but also of those people involved in traffic accidents whom anyone of us may become.

Dissertação de Mestrado apresentada ao Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica.
Os acidentes deixam marcas nos acidentados como lesões que em alguns casos traduzem-se em incapacidade permanente (IP). Este estudo pretende tratar dessas situações e perceber a dinâmica da incapacidade provocada pelo acidente de viação e relacioná-la com a perturbação do stress pós-traumático (PSPT). O presente estudo teve como objectivo avaliar a incidência da perturbação do stress pós-traumático numa população proveniente de acidentes de viação num espaço temporal mínimo de dois anos após o acidente e com um grau de incapacidade adquirida (= > a 60% de incapacidade permanente - IP). O grupo de participantes é composto por vinte indivíduos de ambos os sexos. Na recolha dos dados foram utilizados dois instrumentos: Questionário Geral do Acidente (QGA) adaptado a partir do questionário de Oliveira (2009) para caracterizar os dados sócio-demográficos; Escala de Avaliação da Resposta ao Acontecimento Traumático (EARAT) de MacIntyre & Ventura (1996) para avaliar a incidência de stress pós traumático no grupo de participantes. Os resultados demonstram que 55% dos sujeitos da amostra desta investigação tiveram sintomatologia da perturbação do stress pós-traumático (PSPT). A análise das associações entre a perturbação de stress pós-traumático com o género e a idade dos participantes determinou que a associação não foi significativa. A relação entre o nível de perturbação do stress pós-traumático (PSPT) com o tempo decorrido após o acidente e a reincidência de acidentes sofridos demonstrou também não ser significativa para a incidência de stress pós-traumático na população estudada.
Accidents leave marks like lesions which in some cases translates into permanent disability. This study aims to address these situations and understand the dynamics of disability caused by traffic accidents and relate it to the disturbance of post traumatic stress disorder (PTSD). This study aims to assess the impact of the disruption of posttraumatic stress in a population from road accidents within a given time of least two years after the accident itself and with a degree of acquired disability (=> 60% permanent disability - PD). The chosen group of twenty participants consists of both sexes. In collecting data we used two instruments: a General Accident Questionnaire (GAQ) adapted from Oliveira (2009) to characterize the socio-demographic data; a Rating Scale Response to Traumatic Event (RSRTE) by MacIntyre & Ventura (1996) to assess the incidence of post-traumatic stress in the group of participants. The results show that 55% of the subjects of this research have had symptoms of the post-traumatic stress disorder (PTSD). The analysis of associations between post traumatic stress disorder with and the age of the participants resulted in a non significant relation. The relationship between the level of disturbance of post traumatic stress disorder (PTSD) with the time elapsed since the accident and the recurrence of accidents also showed to be non significant for the incidence of post-traumatic stress in this population.

D. Litt. et Phil.
This report presents the findings of a study conducted in February-March 1995, involving 109 members of different emergency services from three regions: Pretoria, Durban and Cape Town. The emergency services included in the study were three units of the South African Police Service (Visible Policing, the Internal Stability Unit and the Flying Squad), provincial fire and ambulance services, and municipal traffic services. The aims of the study were to: (1) describe the underlying causes of stress in the emergency services; (2) establish how stress is currently being dealt with by members and identify the structures and support systems available to assist members with stress-related problems; (3) identify constructive and destructive, effective and ineffective mechanisms used by members to cope with their stress, and (4) suggest solutions to problems experienced in managing stress in the emergency services. The study investigated stressors of SAPS members under the following themes: (1) public image of the SAPS, (2) management style in the SAPS, (3) communication in the SAPS, (4) working environment in the SAPS, (5) working conditions and remuneration packages, (6) distinct characteristics of the work of SAPS members, and (7) the priorities set by SAPS members that need to be addressed in order to reduce their level of stress. The stressors of members of the fire and ambulance services were dealt with under the following themes: (1) utilisation of manpower in the organisation, (2) training provided to members, (3) management style in the fire and ambulance services, (4) distinct characteristics of the work of members of the fire and ambulance services, (5) remuneration packages, and (6) the priorities set by members that need to be addressed in order to reduce their level of stress. The stressors of members of the traffic services were dealt with under the following themes: (1) the public image of the traffic services, (2) distinct characteristics of the work of traffic officials, (3) communication in the traffic services, (4) working conditions and remuneration packages and (5) the priorities set by members that need to be addressed in order to reduce their level of stress. Regarding the support members of the emergency services receive within their organisations for managing stress, a number of sources of support were mentioned, such as social workers, psychologists and chaplains in the SAPS, support by supervisors, debriefing after traumatic events, stress management training, nursing sisters at ambulance stations, drinking and socialising, with the biggest form of support being "buddies". Regarding the co-operation between members of the different emergency services, the perception was that there was a very good relationship and good co-operation. Number of problems experienced in their day-to-day contact with each other were however mentioned.

The diploma thesis called "The process of moving towards the optimal supervision system of crisis interventions of the Police of the Czech republic" is connected with the future deriving of the project within the structural fund of European Union. The aims of the project is to support, implement and move to optimal supervision for crisis interventions of the Police of the Czech Republic. The thesis is a first research step for initial ideas about supervision and its systematic implementation to individual regional directorates of the Police of the Czech Republic. The theoretical part is focused on the basic concepts in the field of crisis intervention and supervision. The main chapters are supplemented by topics with an overlap into the system of the Police of the Czech Republic. The empirical part was performed using an online questionnaire survey. The research sample was a set of police crisis interventions from all regions of the Czech Republic, where the crisis assistance is provided by the team of the crisis intervention. There are several aims in the diploma thesis. The main one is to map and to describe the current system of supervision of crisis interventions and to compare individual regions in the area of providing supervision. Another aim is to find out various psychosocial aspects such...