Thailand has the second-highest rates of road traffic mortality globally. Detailed information on the combination of human, vehicle, and environmental risks giving rise to each incident is important for addressing risk factors holistically. This paper presents the result of forensic road traffic investigation reports in Thailand and determines risk factor patterns for road traffic injuries. Detailed forensic reports were extracted for 25 serious traffic accident events. The Haddon matrix was used to analyze risk factors in three phases stratified by four agents. The 25 events analyzed involved 407 victims and 47 vehicles. A total of 65.8% of victims were injured, including 14.5% who died. The majority (66.1%) of deaths occurred at the scene. Human-error-related factors included speeding and drowsiness. Passenger risks included not using the seat belt, sitting in the cargo area and the cab of pickups. Overloaded vehicles, unsafe car modifications, no occupant safety equipment and having unfixed seats were vehicular risks. Environmental risks included fixed objects on the roadside, no traffic lights, no guard rails, no traffic signs, and road accident black spots. At present, traffic accidents cause much avoidable severe injury and death. The outcome of this paper identifies a number of preventable risk factors for traffic injury, and importantly examines them in conjunction. Road traffic safety measures need to consider how human, vehicle, and environmental risks intersect to influence injury likelihood and severity. The Haddon matrix is useful in identifying these pre- and post-accident risk factors. Furthermore, the sustainable preventions of road traffic injury need to address these risks together with active law enforcement.

This study aimed to examine the predictive validity of two internationally well-known instruments, the Modified Home Falls and Accidents Screening Tool (Modified HOME FAST) and the Modified Home Falls and Accidents Screening Tool-Self Report (Modified HOME FAST-SR), and the newly developed Thai Home Falls Hazard Assessment Tool (Thai-HFHAT) (69 items) in predicting falls among older Thai adults. It also aimed to examine the predictive validity of the two abbreviated versions (44 and 27 items) of the Thai-HFHAT, which were developed post hoc to accommodate older adults’ limited literacy and poor vision and to facilitate the identification of high-impact home fall hazards that are prevalent in the Thailand context. A prospective cohort study was conducted among 450 participants aged 60 years and above who were assessed by the aforementioned tools at baseline, for which data on fall incidence were then collected during the one-year follow-up. The Cox proportional hazard model was applied to estimate hazard ratios (HRs); then, Harrell’s C-statistics and receiver operating characteristic (ROC) analyses were conducted to identify the best cutoff point, sensitivity and specificity for each instrument. The results showed that the fall hazard rate was 2.04 times per 1,000 person-days. Taking into account both the predictive validity and applicability, the Thai-HFHAT (44 items) was found to be the most suitable screening tool due to its highest sensitivity and specificity (93% and 72%) at the cutoff score of 18. In conclusion, our study showed that these internationally validated home fall hazard assessment tools were quite applicable for Thailand, but further tailoring the tools into a specific local context yielded even more highly valid tools in predicting fall risk among older Thai adults. Although these findings were well reproducible by inferring from the internal validation results, further external validation in the independent population is necessary.

This cross-sectional descriptive study aimed to describe the health-related quality of life (HRQL) and related factors of the southern Thai patients with stable COPD. The sample consisted of 126 patients with stable COPD attending the out-patient pulmonary clinic of Thasala hospital. The patients were assessed for HRQL by the Saint George's Respiratory Questionnaire (SGRQ), age, BMI, depression, dyspnea by the Modified Medical Research Council (mMRC), exercise capacity by the 6 min walk distance (6MWD), and admission. The results found that 84 % of patients were male, with a mean age of 69.6 years, FEV1 70 (9.6) % predicted, BMI 21.9 (4.4) and 6MWD 259.8 (97.9). The HRQL indicated mild impairment: symptoms 47.1 (22.4), activity 49.7 (30.3), impact 41.9 (21.2) and total scores of 45.1 (21.7). The regression analysis showed that HRQL was significantly associated with exercise capacity, depression, and MRC dyspnea respectively (R2 = 0.492, p < 0.01). Therefore, stable COPD patients should be assessed and motivated to pulmonary rehabilitation for promoting clinical outcomes and also improving their HRQL.

The Thai-Home Fall Hazard Assessment Tool (Thai-HFHAT) was developed to identify the fall risk among the elderly arising from their home environment. However, it is more time consuming for large items. Therefore, this study developed a short-form of Thai-HFHAT (Thai-HFHAT-SF). In phase I, we developed the Thai-HFHAT-SF by performing a confirmatory factor analysis (CFA) of 450 rural elderly people. In phase II, a total of 105 participants; 50 elderly people, 50 caregivers, and 5 village health volunteers (VHV) were recruited to examine the reliability of the Thai-HFHAT-SF. Intra-class correlation coefficient (ICC) was used to analyze the inter-rater and test–retest reliability. Factor analysis selected 28 out of the 69 original Thai-HFHAT items in 4 components: indoor area, garage, outdoor areas, and risky spots/areas including pets. The factor loading was 0.67, 0.60, 0.32, and 0.31 in each component. The fitness index indicated that this model was fit (χ2/df = 1.38, goodness-of-fit Index (GFI) = 0.988, adjusted goodness-of-fit index (AGFI) = 0.970, standardized root mean square residual (SRMR) = 0.030, and root mean square error of approximation (RMSEA) = 0.029). The inter-rater reliability of the Thai-HFHAT-SF was 0.82 (95% CI: 0.71–0.89). The test–retest reliability was 0.77 (95% CI: 0.60–0.87) for the older person group, 0.85 (95% CI: 0.73–0.91) for the caregiver group, and 0.60 (95% CI: 0.29–0.77) for the VHV group. The new 28-item scale focused on home fall hazards and can be conducted in 10–15 min. Thai-HFHAT-SF is suitable for home hazards assessment among elderly in Thailand.

Background – Thailand has the second highest rates of road traffic mortality globally. Detailed information on the combination of human, vehicle and environmental risks giving rise to each incident is important for addressing risk factors holistically. This paper presents the result of forensic road traffic investigation reports in Thailand and determines risk factor patterns for road traffic injuries.Methods – Detailed forensic reports were extracted for 25 serious traffic accident events. For each report, accidents were characterized by the number of vehicles, number and type of injuries and deaths, road user types, involvement of roadside hazards, medical care provided, and human, vehicular and environmental influences on the incident. The Haddon matrix was used to analyse risk factors in three phases (pre-event, event, post-event) stratified by four agents (human, vehicle, physical and socio-economic environment).Results - The 25 events analyzed involved 407 victims and 47 vehicles. 65.8% of victims were injured, including 22.0% who died. Median age of those injured was 27 years, and 28 years for fatalities. Vehicles crashing with fixed objects, and pickup-related crashes, accounted for the majority of accidents and deaths. Head or neck trauma was the main cause of death. The majority (61%) of deaths occurred at the scene. Human error-related factors included speeding, and drowsiness from night and long-distance driving. Passenger risks included not using seat belt, sitting in cargo area and the cab of pickups. Not having anyone trained in first aid on the scene, first aid being provided by bystanders, and delayed calls to Emergency Medical Services increased injury risk. Overloaded vehicles, unsafe car modifications, no occupant safety equipment, and having unfixed seats were vehicular risks. Environmental risks included fixed objects on the roadside, no traffic lights, no guard rails, no traffic sign, road accident black spots, and hazardous objects roadside.Conclusions - Thailand must address all three temporal phases of the Haddon model and all three factors – human, vehicle and environment. At present traffic accidents cause much avoidable severe injury and death. The Haddon matrix is useful to structure road traffic investigations, revealing multi-level factors common on Thai roads. Keywords: Road traffic injury, Risk factor, Road traffic investigation, Haddon matrix