Studies from several countries suggest that erecting fences on bridges more commonly used for suicide by jumping may be an effective way of reducing the risk of suicide by jumping from these bridges. Distribution of suicides by jumping off bridges has not yet been studied on a national level in any country. This study included all suicides by jumping from high places registered in the Norwegian Cause of Death Registry (COD) in the period 1999-2010 (n = 319). Combining data from the COD registry and information from police records, 71 cases of suicide by jumping off a bridge were identified involving 36 bridges. This form of suicide constituted approximately 1% of all suicides in Norway in the period 1999-2010. Almost half of these suicides were registered at only 6 bridges. Three Norwegian bridges were secured during the observation period of this study. Two bridges had barriers installed on the full length of the bridge with 11 suicides registered before barriers were installed, and none after. On the 1 bridge that was only partially secured, no change in numbers of suicides was observed after barriers were installed. One-third of jumps from bridges occurred over land. We found that although suicide by jumping off bridges was a relatively rare event, there is a potential for saving lives by installing physical barriers on bridges that are more commonly used for suicide by jumping.
This paper describes some of the main findings from two separate studies on accident prediction models for urban junctions and urban road links described in [Uheldsmodel for bygader-Del1: Modeller for 3-og 4-benede kryds. Notat 22, The Danish Road Directorate, 1995; Uheldsmodel for bygader- Del2: Modeller for straekninger. Notat 59, The Danish Road Directorate, 1998] (Greibe and Hemdorff, 1995, 1988). The main objective for the studies was to establish simple, practicable accident models that can predict the expected number of accidents at urban junctions and road links as accurately as possible. The models can be used to identify factors affecting road safety and in relation to 'black spot' identification and network safety analysis undertaken by local road authorities. The accident prediction models are based on data from 1036 junctions and 142 km road links in urban areas. Generalised linear modelling techniques were used to relate accident frequencies to explanatory variables. The estimated accident prediction models for road links were capable of describing more than 60% of the systematic variation ('percentage-explained' value) while the models for junctions had lower values. This indicates that modelling accidents for road links is less complicated than for junctions, probably due to a more uniform accident pattern and a simpler traffic flow exposure or due to lack of adequate explanatory variables for junctions. Explanatory variables describing road design and road geometry proved to be significant for road link models but less important in junction models. The most powerful variable for all models was motor vehicle traffic flow.
BACKGROUND AND RATIONALE: The underlying assumption was that the aesthetics of the hospital surroundings are often neglected. AIMS: This article is the first part of a larger study into the aesthetics of general hospitals. The aim of the study is to throw light on the influence of aesthetics on the health and well-being of patients and the professional personnel, and to examine how aesthetic considerations are dealt with. We present a survey of how the aesthetic dimension is planned and it is considered important in the strategic plans of Norwegian general hospitals. METHODS: Data were sampled by analyzing the strategic plans of somatic hospitals. Sixty-four of 86 hospitals responded (74%). Concepts were categorized in a matrix of 11 main categories, each with subcategories. The method was quantitative, in that the analyzed material was amenable to counting. RESULTS: Very few concrete guidelines or directions for the aesthetic dimension have been included in written documents. This indicates that the aesthetic area is a neglected field in the directions for the daily management of hospitals. CONCLUSIONS: The research available today on the contribution of environmental aesthetics to health, rehabilitation, and well-being suggests that it is important to have concrete guidelines recorded in strategic plans. This field concerns the maintenance of high quality in the caring professions.
Throughout the world all populations are seeing burgeoning numbers of "elders", defined as persons aged 65 year and older. In many countries, including Japan, the United States, Norway, Sweden and the United Kingdom, those aged over 65 are at or approaching 15% of the population. As their numbers have increased, so have their health care expenses, leading to extensive research on the health, well being, and life expectancy of these increasingly older elders. Today this group is further sub-divided: the young-old ages 65-74, the old-old ages 75-84, and the oldest-old ages 85+, for both health care and research purposes. However broad variation still characterizes even these groupings. Rates of frailty and disability increase with increasing age among these elders. For example, inabilities to complete at least one activity of daily living increased from about 5-7% at ages 65-69 years to about 28-36% at ages 85+ in 1987. Death rates continue to decline at all ages past 50 years and rates of disability seem to be doing the same. For the foreseeable future, we may expect increasing numbers of older, frail elders than in previous decades. Thus, people are not only living longer, they generally are healthier at advanced ages than were previous cohorts, thus "old age" disabilities of the 20th century will be put off to even older ages during the 21st century. As yet there is no clear way to assess senescent changes in humans, although activities of daily living, allostatic load, and frailty indices have all been suggested. One future need is greater development and use of universal and accessible design in all aspects of the built environment.
The authors investigated the use of Google Earth's Street View option to audit the presence of built environment features that support older adults' walking. Two raters conducted virtual (Street View) and in-the-field audits of 48 street segments surrounding urban and suburban assisted living sites in metropolitan Vancouver, BC, Canada. The authors determined agreement using absolute agreement. Their findings indicate that Street View may identify the presence of features that promote older adults' walking, including sidewalks, benches, public washrooms, and destinations. However, Street View may not be as reliable as in-the-field audits to identify details associated with certain items, such as counts of trees or street lights; presence, features, and height of curb cuts; and sidewalk continuity, condition, and slope. Thus, the appropriateness of virtual audits to identify microscale built environment features associated with older adults' walking largely depends on the purpose of the audits-specifically, whether the measurer seeks to capture highly detailed features of the built environment.
Conducting rigorous before-and-after studies is essential for improving knowledge regarding the effects of road safety measures. However, state-of-the-art approaches like the empirical Bayes or fully Bayesian techniques cannot always be applied, as the data required by these approaches may be missing or unreliable. The choice facing researchers in such a situation is to either apply "second-best" approaches or abstain from doing an evaluation study. An objection to applying second-best approaches is that these approaches do not control as well for confounding factors as state-of-the-art approaches. This paper explores the implications of choice of study design by examining how the findings of several evaluation studies made in Norway depend on choices made with respect to: 1. Using the empirical Bayes approach versus using simpler approaches; 2. Use or non-use of a comparison group; 3. The choice of comparison group when there is more than one candidate. It is found that the choices made with respect to these points can greatly influence the estimates of safety effects in before-and-after studies. Two second-best techniques (i.e. techniques other than the empirical Bayes approach) for controlling for confounding factors were tested. The techniques were found not to produce unbiased estimates of effect and their use is therefore discouraged.
Traffic congestion is rapidly becoming the most important obstacle to urban development. In addition, traffic creates major health, environmental, and economical problems. Nonetheless, automobiles are crucial for the functions of the modern society. Most proposals for sustainable traffic solutions face major political opposition, economical consequences, or technical problems.
We performed a decision analysis in a poorly studied area, trip aggregation, and studied decisions from the perspective of two different stakeholders, the passenger and society. We modelled the impact and potential of composite traffic, a hypothetical large-scale demand-responsive public transport system for the Helsinki metropolitan area, where a centralised system would collect the information on all trip demands online, would merge the trips with the same origin and destination into public vehicles with eight or four seats, and then would transmit the trip instructions to the passengers' mobile phones.
We show here that in an urban area with one million inhabitants, trip aggregation could reduce the health, environmental, and other detrimental impacts of car traffic typically by 50-70%, and if implemented could attract about half of the car passengers, and within a broad operational range would require no public subsidies.
Composite traffic provides new degrees of freedom in urban decision-making in identifying novel solutions to the problems of urban traffic.
This paper presents an Empirical Bayes before-after evaluation of the road safety effects of a new motorway (freeway) in Østfold county, Norway. The before-period was 1996-2002. The after-period was 2009-2015. The road was rebuilt from an undivided two-lane road into a divided four-lane road. The number of killed or seriously injured road users was reduced by 75 percent, controlling for (downward) long-term trends and regression-to-the-mean (statistically significant at the 5 percent level; recorded numbers 71 before, 11 after). There were small changes in the number of injury accidents (185 before, 123 after; net effect -3%) and the number of slightly injured road users (403 before 279 after; net effect +5%). Motorways appear to mainly reduce injury severity, not the number of accidents. The paper discusses challenges in implementing the Empirical Bayes design when less than ideal data are available.
Today, North American governments are more willing to consider compact neighborhoods with increased use of sustainable transportation modes. Bicycling, one of the most effective modes for short trips with distances less than 5km is being encouraged. However, as vulnerable road users (VRUs), cyclists are more likely to be injured when involved in collisions. In order to create a safe road environment for them, evaluating cyclists' road safety at a macro level in a proactive way is necessary. In this paper, different generalized linear regression methods for collision prediction model (CPM) development are reviewed and previous studies on micro-level and macro-level bicycle-related CPMs are summarized. On the basis of insights gained in the exploration stage, this paper also reports on efforts to develop negative binomial models for bicycle-auto collisions at a community-based, macro-level. Data came from the Central Okanagan Regional District (CORD), of British Columbia, Canada. The model results revealed two types of statistical associations between collisions and each explanatory variable: (1) An increase in bicycle-auto collisions is associated with an increase in total lane kilometers (TLKM), bicycle lane kilometers (BLKM), bus stops (BS), traffic signals (SIG), intersection density (INTD), and arterial-local intersection percentage (IALP). (2) A decrease in bicycle collisions was found to be associated with an increase in the number of drive commuters (DRIVE), and in the percentage of drive commuters (DRP). These results support our hypothesis that in North America, with its current low levels of bicycle use (