Displaying publications 1 - 20 of 31 in total

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  1. Krishnan R, Cheng OT, Amar Singh HSS, Wong WY, Yip RCW, Shamini V
    Family Physician, 1996;9:17-22.
    Bicycle fatalities constituted 5% of road fatalities in 1995. A helmet, properly worn, is the most effective measure to prevent head injury to a cyclist in the event of a crash. We studied the knowledge, attitude and practice of children in two secondary schools (Ipoh and Kulim) with respect to bicycle helmet use before instituting a program for helmet use. Although there were no major differences in knowledge, attitude and practice of students in the two groups, children in the Ipoh program failed to wear helmets while the children in the Kulim program complied over a one year period. The main reason for failure of the helmet progranl in Ipoh were negative peer influence. The Kulim helmet program was integrated with a bicycle safety course conducted by dedicated teachers. The quasi experimental study resulted in increased awareness of the importance of bicycle helmets among school children in Kulim Keywords: Bicycle helmet, road traffic injury, prevention.
    Matched MeSH terms: Head Protective Devices
  2. Kulanthayan S, Umar RS, Hariza HA, Nasir MTM, Harwant S
    Med J Malaysia, 2000 Mar;55(1):40-4.
    PMID: 11072489 MyJurnal
    Motorcyclists make up the largest group of fatalities on Malaysian roads, majority succumbing to head injuries despite the compulsory safety helmet laws in the country. One possible reason for this high fatality is improper usage of safety helmets. This study examines the compliance of proper safety helmet use in motorcyclists in a typical Malaysian town. Five hundred motorcyclists were studied. Only 54.4% of motorcyclists used helmets properly, 21.4% used them improperly; and 24.2% did not wear helmets. Six variables were found to be significant in improper safety helmet use. They were age, gender, race, formal education level, prior accident experience and type of license held. Marital status and riding experience were not significant. Efforts promoting proper use of safety helmets should focus on the young, male, less formally educated, unlicensed rider, who has had a prior accident.
    Matched MeSH terms: Head Protective Devices/utilization*; Head Protective Devices/statistics & numerical data
  3. Hyder AA, Waters H, Phillips T, Rehwinkel J
    Asia Pac J Public Health, 2007;19(2):16-22.
    PMID: 18050559
    This paper reviews economic evaluations of motorcycle helmet interventions in preventing injuries. A comprehensive literature review focusing on the effectiveness of motorcycle helmet use, and on mandatory helmet laws and their enforcement was done. When helmet laws were lifted between 1976-80, 48 states within the U.S.A. experienced a cost of $342,047 per excess fatality of annual net savings. Helmet laws in the USA had a benefit-cost ratio of 1.33 to 5.07. Taiwan witnessed a 14% decline in motorcycle fatalities and a 22% reduction of head injury fatalities with the introduction of a helmet law. In Thailand, where 70-90% of all crashes involve motorcycle, after enforcement of a helmet law, helmet-use increased five-fold, the number of injured motorcyclists decreased by 33.5%, head injuries decreased by 41.4%, and deaths decreased by 20.8%. There is considerable evidence that mandatory helmet laws with enforcement alleviate the burden of traffic injuries greatly. For low and middle-income countries with high rates of motorcycle injuries, enforced, mandatory motorcycle helmet laws are potentially one of the most cost-effective interventions available.
    Matched MeSH terms: Head Protective Devices/utilization*
  4. Ramli R, Abdul Rahman R, Abdul Rahman N, Abdul Karim F, Krsna Rajandram R, Mohamad MS, et al.
    J Craniofac Surg, 2008 Mar;19(2):316-21.
    PMID: 18362705 DOI: 10.1097/SCS.0b013e318163f94d
    Motorcycle casualties represent significant number in road traffic accidents in Malaysia, and among all the injuries, facial injuries pose many significant problems physiologically, functionally, and aesthetically. The aim of this study was to analyze the pattern of maxillofacial as well as other injuries in motorcyclists who were seen at Hospital Universiti Kebangsaan Malaysia.Patients' records from January 2004 to December 2005 were reviewed. Data related to demographics, vehicle/object involved in collision, involvement as a rider or pillion, whether a helmet was worn or not, location of injuries on the face/facial bones, and other associated injuries were collected.A total of 113 cases of motorcycle accidents were recorded; 106 males and 7 females were involved. Mean age was 25.8 years. Among all the races, Malay had the highest involvement (72.3%), followed by Chinese (14.3%), Indians (8.9%), and others (5.4%). The types of collision were either a single-vehicle collision (i.e., skidded) or with another vehicle/s or object (e.g., tree, stone, or lamppost). The injuries were mainly seen on the lower face (46.9%) followed by midface (25.7%) and a combination of the midface and lower face (15%) and others (12.4%). The most frequent other associated injuries recorded were orthopedic and head injuries.
    Matched MeSH terms: Head Protective Devices/statistics & numerical data
  5. Ooi SS, Wong SV, Yeap JS, Umar R
    Asia Pac J Public Health, 2011 Jul;23(4):608-19.
    PMID: 21768134 DOI: 10.1177/1010539511413750
    Motorcycle helmets have been proven to prevent head injury and reduce fatality in road crashes. However, certain studies indicate that the helmet increases the mass to the head, and thus the potential of neck injury due to the flexion/extension of the head-neck segment in a road crash may increase. This study was conducted to evaluate the effects of motorcycle helmets and the ways in which the accidents that occurred affected the incidence of cervical spine injury. Nevertheless, it is not intended to and does not discredit the fact that helmet use prevents many motorcyclists from sustaining serious and fatal head injuries. A total of 76 cases were collected and analyzed based on the data collected from real-world crashes. The Abbreviated Injury Scale (AIS) was used to assess the severity of injury, whereas the statistical Pearson χ(2) correlation method was used for analysis. The results showed that motorcycle helmets did not affect the severity of cervical spine injury. However, when the samples were further subcategorized into different crash modes, it was found that helmets affect the incidence of a severe cervical spine injury. In frontal collisions, the use of helmets significantly reduces the severity of cervical spine injury, whereas in rear-end, side impact, and skidded accidents, the use of helmets increases the probability of a severe cervical spine injury. However, in the latter crash modes, a motorcyclist without a helmet will have to trade-off with head injury. A logistic regression model has been developed with respective crash modes and the probabilities of risk in having severe cervical spine injury have been calculated. Future designs in motorcycle helmets should therefore consider the significance of nonfrontal accidents and the interaction of helmet with other parts of the body by possibly considering the weight of the helmet.
    Matched MeSH terms: Head Protective Devices/utilization*
  6. Kulanthayan S, See LG, Kaviyarasu Y, Nor Afiah MZ
    Injury, 2012 May;43(5):653-9.
    PMID: 21764054 DOI: 10.1016/j.injury.2011.06.197
    BACKGROUND: Almost half of the global traffic crashes involve vulnerable groups such as pedestrian, cyclists and two-wheeler users. The main objective of this study was to determine the factors that influence standard of the safety helmets used amongst food delivery workers by presence of Standard and Industrial Research Institute of Malaysia (SIRIM) certification label.
    METHODS: A cross sectional study was conducted amongst 150 food delivery workers from fast food outlets in the vicinity of Selangor and Kuala Lumpur. During observation, safety helmets were classified as standard safety helmet in the presence of SIRIM label and non-standard in the absence of the label. They were approached for questionnaire participation once consent was obtained and were requested to exchange their safety helmet voluntarily with a new one after the interview. Data analysis was carried out using SPSS. Chi square and logistic regression analysis was applied to determine the significance and odds ratio of the variables studied, respectively (penetration test, age, education level, knowledge, crash history, types of safety helmet, marital status and years of riding experience) against the presence of SIRIM label.
    RESULTS: The response rate for this study was 85.2%. The prevalence of non-standard helmets use amongst fast food delivery workers was 55.3%. Safety helmets that failed the penetration test had higher odds of being non-standard helmets compared with safety helmets passing the test. Types of safety helmet indicated half-shell safety helmets had higher odds to be non-standard safety helmets compared to full-shell safety helmets. Riders with more years of riding experience were in high odds of wearing non-standard safety helmets compared to riders with less riding experience.
    CONCLUSION: Non-standard (non-SIRIM approved) helmets were more likely to be half-shell helmets, were more likely to fail the standards penetration test, and were more likely to be worn by older, more experienced riders. The implications of these findings are discussed.
    Matched MeSH terms: Head Protective Devices/standards*; Head Protective Devices/utilization*
  7. Law TH, Noland RB, Evans AW
    Risk Anal, 2013 Jul;33(7):1367-78.
    PMID: 23106188 DOI: 10.1111/j.1539-6924.2012.01916.x
    It has been shown that road safety laws, such as motorcycle helmet and safety belt laws, have a significant effect in reducing road fatalities. Although an expanding body of literature has documented the effects of these laws on road safety, it remains unclear which factors influence the likelihood that these laws are enacted. This study attempts to identify the factors that influence the decision to enact safety belt and motorcycle helmet laws. Using panel data from 31 countries between 1963 and 2002, our results reveal that increased democracy, education level, per capita income, political stability, and more equitable income distribution within a country are associated with the enactment of road safety laws.
    Matched MeSH terms: Head Protective Devices*
  8. Ab Rahman WS, Abdullah WZ, Mustaffa R, Ahmed SA, Hassan MN, Husin A
    PMID: 24093001 DOI: 10.4137/CCRep.S12122
    Thrombotic thrombocytopenic purpura (TTP) is a medical emergency characterized by occlusive microangiopathy due to intravascular platelet aggregation. This event results in damage to the red blood cells (RBCs) known as microangiopathic hemolytic anemia (MAHA). Schistocytes are circulating fragments of damaged RBCs that have different morphological features including keratocytes, helmet cells, and spherocytes. It is critical to report even a small number of these abnormal RBCs in the peripheral blood and to be alert for the possible diagnosis of TTP, especially in unexplained anemia and thrombocytopenia. The application of pentad criteria in the diagnosis has been reviewed, and the challenges still remained on the hematologic evidence of this disorder. In the 3 cases discussed here, the red cell morphological diagnosis gave an impact on TTP diagnosis, but overdiagnosis might be encountered in obstetrical patients due to nonspecific diagnostic criteria.
    Matched MeSH terms: Head Protective Devices
  9. Oxley J, Yuen J, Ravi MD, Hoareau E, Mohammed MA, Bakar H, et al.
    Ann Adv Automot Med, 2014 1 11;57:45-54.
    PMID: 24406945
    In Malaysia, two-thirds of reported workplace-related fatal and serious injury incidents are the result of commuting crashes (especially those involving motorcyclists), however, little is known about the contributing factors to these collisions. A telephone survey of 1,750 motorcyclists (1,004 adults who had been involved in a motorcycle commuting crash in the last 2 years and 746 adult motorcyclists who had not been involved in a motorcycle crash in the last 2 years) was undertaken. The contributions of a range of behavioural, attitudinal, employment and travel pattern factors to collision involvement were examined. The findings revealed that the majority of participants were licensed riders, rode substantial distances (most often for work purposes), and reported adopting safe riding practices (helmet wearing and buckling). However, there were some concerning findings regarding speeding behaviour, use of mobile phones while riding, and engaging in other risky behaviours. Participants who had been involved in a collision were younger (aged 25-29 years), had higher exposure (measured by distances travelled, frequency of riding, and riding on high volume and higher speed roads), reported higher rates of riding for work purposes, worked more shift hours and had a higher likelihood of riding at relatively high speeds compared with participants who had not been involved in a collision. Collisions generally occurred during morning and early evening hours, striking another vehicles, and during normal traffic flow. The implications of these findings for policy decisions and development of evidence-based behavioural/training interventions addressing key contributing factors are discussed.
    Matched MeSH terms: Head Protective Devices
  10. Oxley J, Ravi MD, Yuen J, Hoareau E, Hashim HH
    Ann Adv Automot Med, 2014 1 11;57:329-36.
    PMID: 24406968
    In Malaysia, motorcycle crashes constitute approximately 60 percent of all road trauma, and a substantial proportion involve children 16 years and younger. There are, however, many gaps in our knowledge on contributing factors to crashes and injury patterns amongst children killed and seriously injured in motorcycle crashes. The aim of this study was to examine fatal and serious injury motorcycle-related collisions to identify contributing factors and injury patterns amongst child motorcyclists. All identified motorcyclist fatal crashes between 2007 and 2011 (inclusive) were extracted from the national Police-reported crash database (M-ROADS) and a range of variables were selected for examination. A total of 17,677 crashes were extracted where a rider or pillion was killed and of these crashes 2,038 involved children, equating to 12 percent. Examination of crashes involving children revealed that some crashes involved more than two children on the motorcycle, therefore, overall children constituted 9.5% of fatal and 18.4% of serious injury collisions. A high proportion of child fatal or serious injury collisions involved the child as the rider (62%), and this was most common for children aged between 10 and 16 years. The majority of collisions occurred on rural roads, in speed limit zones of 50-70km/h, and approximately one-third occurred at an intersection. Collisions involving another motorcycle or a passenger vehicle contributed to 41% and 53% of the total fatalities and severe injuries, respectively. A high proportion (43.9%) of the children (25.5% riders and 18.8% pillion) sustained head injuries with 37.7% being in the 10-16 age group. Furthermore, 52.4% of the children sustaining head injuries did not wear a helmet. The implications of these findings for countermeasures within a Safe System framework, particularly interventions aimed at reducing the rate of unlicensed riding and helmet wearing, and infrastructure countermeasures are discussed.
    Matched MeSH terms: Head Protective Devices
  11. Ramli R, Oxley J, Noor FM, Abdullah NK, Mahmood MS, Tajuddin AK, et al.
    J Forensic Leg Med, 2014 Aug;26:39-45.
    PMID: 25066171 DOI: 10.1016/j.jflm.2014.06.007
    Motorcycle fatalities constitute the majority of road traffic deaths in Malaysia. The aims of this study were to describe the pattern of fatal injuries among Klang Valley fatal motorcyclists and to describe the factors associated with fatal (vs non-fatal) injuries.
    Matched MeSH terms: Head Protective Devices/utilization
  12. Ramli R, Oxley J, Hillard P, Mohd Sadullah AF, McClure R
    BMC Emerg Med, 2014;14:17.
    PMID: 25086638 DOI: 10.1186/1471-227X-14-17
    The effectiveness of helmets in reducing the risk of severe head injury in motorcyclists who were involved in a crash is well established. There is limited evidence however, regarding the extent to which helmets protect riders from facial injuries. The objective of this study was to determine the effect of helmet type, components and fixation status on the risk of facial injuries among Malaysian motorcyclists.
    Matched MeSH terms: Head Protective Devices*
  13. Sivasankar S, Karmegam K, Bahri MT, Naeini HS, Kulanthayan S
    Traffic Inj Prev, 2014;15(6):564-71.
    PMID: 24484430 DOI: 10.1080/15389588.2013.861596
    Motorcycles are a common mode of transport for most Malaysians. Underbone motorcycles are one of the most common types of motorcycle used in Malaysia due to their affordable price and ease of use, especially in heavy traffic in the major cities. In Malaysia, it is common to see a young or child pillion rider clinging on to an adult at the front of the motorcycle. One of the main issues facing young pillion riders is that their safety is often not taken into account when they are riding on a motorcycle. This article reviews the legally available systems in child safety for underbone motorcycles in Malaysia while putting forth the need for a safety system for child pillion riders.
    Matched MeSH terms: Head Protective Devices
  14. Roehler DR, Ear C, Parker EM, Sem P, Ballesteros MF
    Int J Inj Contr Saf Promot, 2015;22(2):165-71.
    PMID: 24499413 DOI: 10.1080/17457300.2013.876050
    This study examines the risk characteristics of fatal motorcycle crashes in Cambodia over a 5-year period (2007-2011). Secondary data analyses were conducted using the Cambodia Road Crash and Victim Information System, the only comprehensive and integrated road crash surveillance system in the country. Researchers from the Centers for Disease Control and Prevention and Handicap International found that (1) males are dying in motorcycle crashes roughly seven times more frequently than females; (2) motorcyclist fatalities increased by about 30% from 2007 to 2011; (3) the motorcyclist death rates per 100,000 population increased from 7.4 to 8.7 deaths from 2007 to 2011; and (4) speed-related crashes and not wearing motorcycle helmet were commonly reported for motorcyclist fatalities at approximately 50% and over 80% through the study years, respectively. Additionally, this study highlights that Cambodia has the highest motorcycle death rate in South-East Asia, far surpassing Thailand, Malaysia, and Myanmar. By recognising the patterns of fatal motorcycle crashes in Cambodia, local road-safety champions and stakeholders can design targeted interventions and preventative measures to improve road safety among motorcyclists.
    Matched MeSH terms: Head Protective Devices/trends; Head Protective Devices/utilization*
  15. Mohd Naim Abdullah, Mustapha, F., Muda, M.K.H., Arrifin, M.K.A., Rafie, A.S.M., Shamsudin, M.A.
    Movement Health & Exercise, 2015;4(1):77-91.
    MyJurnal
    Finite Element Analysis (FEA) and Computational Fluid Dynamics (CFD) analysis were performed in this work in order to obtain the best design for safety and aerodynamic performance of the bicycle cycling helmet. FEA analysis was computed on two different helmet designs to determine the critical area subjected to impact. A pressure load was applied on the helmets’ outer surface to simulate oblique loading. The critical areas of the helmets were then highlighted and identified, enabling design improvements to be made on both designs. CFD analysis was then executed in order to obtain the lowest drag coefficient number in reducing the air resistance induced by both of the helmet designs, inherently increasing cyclist performance and ensuring competition success.
    Matched MeSH terms: Head Protective Devices
  16. Ramli R, Che Man Z, Nordin R, Abdul Karim F, Rashdi MF, Oxley J, et al.
    Traffic Inj Prev, 2016 Sep;17 Suppl 1:79-85.
    PMID: 27586107 DOI: 10.1080/15389588.2016.1203428
    OBJECTIVE: Vietnamese spend hours travelling on the road using their motorcycles. Their helmets are exposed continuously to sunlight and rain. The objectives of this study were to determine the association between the effect of photo-oxidative degradation (POD) of the outer shells and helmet age on helmet damage. The micro-structural change of the outer shell was also investigated.

    METHODS: This was a prospective, cross sectional study recruiting injured motorcyclists from Hanoi, Vietnam hospital. The participants were interviewed by a trained researcher. The participants' helmets were collected post-crash. Initially, the helmets were examined for their type and external characteristics. A 3 cm × 3 cm cut was made on the helmet in the impacted and non-impacted areas (control). These areas were investigated for evidence of POD and presence of micro-cracks and material disintegration. 50 participants were enrolled. Sources of information included questionnaire and laboratory analyses. The helmet factors of interest were age of the helmet, exposure of helmet to sunlight and rain (duration/day) and history of previous impact. Laboratory analyses included Fourier Transform Infra Red (FTIR) for degradation and scanning electron microscopy (SEM) for micro-structural examination.

    RESULTS: Majority of the helmets was the open-face type, 40 (80.0%). 31 (62.0%) helmets aged less than three years (LTY) and 19 (38.0%) were three years old or more (MTY). 19 (61.3%) of the LTY helmets and 12 (63.2%) MTY helmets showed evidence of POD. The duration of helmet exposure to sunlight was between 93 to 6570 hours (mean 2347.74 hours; SD 1733.39). The SEM showed 15 helmets (30%) with micro-fractures, 21 helmets (42.0%) with material disintegration. Prolonged uv exposure to the ABS helmets resulted in changes in the helmet material in the form of material disintegration and microcracks and this association was statistically significant (p = 0.03).

    CONCLUSION: POD occurs due to routine exposure to the ultraviolet light. Prolonged uv exposure affects outer shell surface material integrity.

    Matched MeSH terms: Head Protective Devices/standards*
  17. Ramli R, Oxley J
    Injury, 2016 Nov;47(11):2442-2449.
    PMID: 27645615 DOI: 10.1016/j.injury.2016.09.022
    INTRODUCTION: In Malaysia, motorcyclists continue to outnumber other road users in injuries and deaths. The objective of this study was to determine the association between helmet fixation and helmet type with head injury and severity of head injury among Malaysian motorcyclists.

    METHODS: The study design was a prospective cross-sectional study. The participants involved injured motorcyclists who were admitted in five selected hospitals in Klang Valley, Malaysia. Participants who sustained head injury were selected as the cases while those with injury below the neck (IBN) were selected as the controls. Questionnaire comprising motorcyclist, vehicle, helmet and crash factors was examined. Diagnoses of injuries were obtained from the participants' medical records.

    RESULTS: The total subjects with head injuries were 404 while those with IBN were 235. Majority of the cases (76.2%) and controls (80.4%) wore the half-head and open-face helmets, followed by the tropical helmets (5.4% and 6.0% of the cases and controls, respectively). Full-face helmets were used by 1.2% of the cases and 4.7% of the controls. 5.7% of the cases and 6.0% of the controls did not wear a helmet. 32.7% of the cases and 77.4% of the controls had their helmets fixed. Motorcyclists with ejected helmets were five times as likely to sustain head injury [adjusted odds ratio, AOR 5.73 (95% CI 3.38-9.73)] and four times as likely to sustain severe head injury [AOR of 4.83 (95% CI 2.76-8.45)]. The half head and open face helmets had AOR of 0.24 (95% CI 0.10-0.56) for severe head injury when compared to motorcyclists who did not wear a helmet.

    CONCLUSION: Helmet fixation is more effective than helmet type in providing protection to the motorcyclists.

    Matched MeSH terms: Head Protective Devices/adverse effects; Head Protective Devices/utilization*
  18. Nurzuhairiza Zolkifli, Shamsul Bahri Mohd Tamrin, Ng Yee Guan, Nur Shuhada Mohd Shukoor, Nur Fitriyah Md Akir, Ng Gin Siong, et al.
    MyJurnal
    Safety helmet become vital personal protective equipment especially in the plantation in preventing the head from injury. This study evaluate the knowledge, attitude and practice on safety helmet usage among harvesters, the association between knowledge, attitude and practice of safety helmet usage with head injury; and the significant differences of the safety helmet practices before and after the intervention. A cross-sectional study was conducted among 109 harvesters in two oil palm plantation located in Selangor, Malaysia. A set of questionnaire was used to collect the socio demographic background data, knowledge, attitude and practice on the usage of safety helmet. An intervention program through tool box talk on proper usage of safety helmet also was given followed by an observation to look for the differences before and after the tool box promotion on the use of safety helmet. Result from the descriptive analysis showed high score for knowledge, fair score for the attitude and practice among harvesters. There is no association between knowledge (X2=2.733; p>0.05), attitude (X2=2.546; p>0.05) and practice (X2=2.473; p>0.05) with the head injury. The result also gave no significant differences (p>0.05) of the practices before and after the intervention. However, the trends showed decrease in number of practices after the intervention. This study reveals that the knowledge, attitude and practice are not a prominent indicator for head injury among harvesters.
    Matched MeSH terms: Head Protective Devices
  19. Nikmatin S, Hermawan B, Irmansyah I, Indro MN, Kueh ABH, Syafiuddin A
    Materials (Basel), 2018 Dec 22;12(1).
    PMID: 30583516 DOI: 10.3390/ma12010034
    The performance of helmet prototypes fabricated from acrylonitrile butadiene styrene composites filled with oil palm empty fruit bunch fibers was evaluated. The fibers were produced using a milling procedure, while the composites were fabricated using a single-screw extrusion. The physical characteristics of the produced fibers, which are water content, size, and density, were investigated. In addition, the mechanical properties of the produced helmets, including shock absorption, yield stress, frequency, and head injury criterion (HIC), were examined. The impact strength of the produced helmets increases with the rise of filler content. In addition, the helmets were also able to withstand a considerable pressure such that the transmitted pressure was far under the maximum value acceptable by the human skull. The present work also found that HICs exhibited by the investigated helmet prototypes fulfill all the practical guidelines as permitted by the Indonesian government. In terms of novelty, such innovation can be considered the first invention in Indonesia since the endorsement of the use of motorcycle helmets.
    Matched MeSH terms: Head Protective Devices
  20. Suzilawati Mohamed Ariffin, Mimi Nor Aliza Setapani
    MyJurnal
    Malaysia has the highest road fatality risk (per 100,000 populations) compared to other ASEAN nations and more than 50% of the road accident fatalities involving motorcyclists. Hence, this becomes the leading cause of death among young people, aged 15–29 years. The most common cause of fatalities involving motorcyclist is the head injury., This present study aimed to evaluate the knowledge, attitude, and practice on helmet usage among secondary school students in Kuantan. A descriptive cross-sectional design (two months of data collection) was used in this study. Questionnaires were distributed to 200 participants from two schools in Kuantan. The main finding of this study suggests that common reason for the participants to wear a helmet is that ‘it can save a life’. Besides that, the poor practice regarding helmet usage was also found as only 4.5% of them wore the helmet all the time. However, the overall result showed that most of the participants have a good knowledge and positive attitude regarding utilization of helmet.
    Matched MeSH terms: Head Protective Devices
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