Health assessment of commercial drivers: a meta-narrative systematic review

Can job stress, health status and risky driving behaviours predict the crash risk level of taxi drivers? New evidence from China

Despite statistics indicating that China has the world's largest taxi industry, there exists limited research about the relationship between workplace health hazards and taxi driver occupational crashes. In this paper, a cross-sectional survey of taxi drivers in four typical Chinese cities was conducted, and data on their self-reported job stress, health status, and daily risky driving behaviours, together with crash involvement experience in the two years before the survey was collected. Three hypotheses were then developed, and they were verified via multivariate analysis of variance (MANOVA) that the seriousness of drivers' health problems and the frequency of their daily risky driving behaviours could be the accurate predictor of their crash risk of taxi drivers. These factors were subsequently substituted in a bivariate negative binomial (BNB) distribution model to determine the joint rate of at-fault taxi drivers' involvement in property-damage-only (PDO) and personal-injury (PI) crashes. The results offer some useful advice for policy development to decrease and prevent professional taxi drivers from causing severe traffic crashes.

Correlation between visuo-cognitive tests and simulator performance of commercial drivers in the United States

BACKGROUND

Driving commercial vehicles requires intact visuo-cognitive skills. Approximately 13% of all fatal motor vehicle crashes in the United States involve commercial drivers. The ability to accurately predict risk factors for unsafe commercial driving is essential for public safety. Accurate prediction tools will advance the field of commercial driver science, provide policy guidance for driver testing and assist healthcare providers during testing. Prior studies have correlated clinical tools to roadway safety; translating these results to commercial drivers has not yet been done.

OBJECTIVE

This study aimed to identify specific demographic, driving history and visuo-cognitive test results that correlate with driving simulator performance. Using the Cumulative Simulator Score (CSS) as a surrogate for driving ability, the objective was to correlate both sets of data (self-reported and visuo-cognitive testing) with the CSS to identify screening tools for unsafe driving in commercial drivers.

PRINCIPAL RESULTS

Baseline assessments of 120 variables were collected from October 2020 to January 2022. Of the 31 participants, 3 were female and 28 were male with a mean age of 53 years. Average BMI was 32, blood pressure 136/84, 32 years of CDL driving experience, 36,500 annual CDL mileage, 11,000 annual personal mileage, 14 years of education, average number of medications: 2, average number of medical conditions: 2, six participants with personal and/or commercial crashes or tickets in past five years, MOCA 27/30, Trails B time 66 s, UFOV Speed of Processing 15 ms, Stroke Disease Severity Assessment pass rate 94 %. The Cumulative Simulator Score (CSS), correlated significantly with education (r = 0.42; p = 0.02), commercial driving experience (r = 0.42; 0 = 0.02), and number of tickets as a commercial driver (Spearman rho = 0.40; p = 0.02). In a stepwise multivariable linear regression analysis, the number of tickets as a CDL driver in the past five years and years of education were retained as significant variables in the multivariable linear regression model, explaining 38 % of the variance of total scores on the CSS.

MAJOR CONCLUSIONS

Descriptive and self-reported driving characteristics correlate better with the Cumulative Simulator Score in CDL drivers than visuo-cognitive tests. Since simulator performance has been shown to be a reliable surrogate for driving performance, the number of tickets as a CDL driver in the past five years and years of education can be considered as additions to annual physicals for policy makers and health care providers to help assess their on-the-road safety.

A multicomponent structured health behaviour intervention to improve physical activity in long-distance HGV drivers: the SHIFT cluster RCT

Background

Long-distance heavy goods vehicle drivers are exposed to a multitude of risk factors associated with their occupation. The working environment of heavy goods vehicle drivers provides limited opportunities for a healthy lifestyle, and, consequently, heavy goods vehicle drivers exhibit higher than nationally representative rates of obesity and obesity-related comorbidities, and are underserved in terms of health promotion initiatives.

Objective

The aim of this trial was to test the effectiveness and cost-effectiveness of the multicomponent Structured Health Intervention For Truckers (SHIFT) programme, compared with usual care, at both 6 months and 16–18 months.

Design

A two-arm cluster randomised controlled trial, including a cost-effectiveness analysis and process evaluation.

Setting

Transport depots throughout the Midlands region of the UK.

Participants

Heavy goods vehicle drivers.

Intervention

The 6-month SHIFT programme included a group-based interactive 6-hour education session, health coach support and equipment provision [including a Fitbit® (Fitbit Inc., San Francisco, CA, US) and resistance bands/balls to facilitate a ‘cab workout’]. Clusters were randomised following baseline measurements to either the SHIFT arm or the control arm.

Main outcome measures

Outcome measures were assessed at baseline, with follow-up assessments occurring at both 6 months and 16–18 months. The primary outcome was device-measured physical activity, expressed as mean steps per day, at 6-month follow-up. Secondary outcomes included device-measured sitting, standing, stepping, physical activity and sleep time (on any day, workdays and non-workdays), along with adiposity, biochemical measures, diet, blood pressure, psychophysiological reactivity, cognitive function, functional fitness, mental well-being, musculoskeletal symptoms and work-related psychosocial variables. Cost-effectiveness and process evaluation data were collected.

Results

A total of 382 participants (mean ± standard deviation age: 48.4 ± 9.4 years; mean ± standard deviation body mass index: 30.4 kg/m2 ± 5.1 kg/m2; 99% male) were recruited across 25 clusters. Participants were randomised (at the cluster level) to either the SHIFT arm (12 clusters, n = 183) or the control arm (13 clusters, n = 199). At 6 months, 209 (54.7%) participants provided primary outcome data. Significant differences in mean daily steps were found between arms, with participants in the SHIFT arm accumulating 1008 more steps per day than participants in the control arm (95% confidence interval 145 to 1871 steps; p = 0.022), which was largely driven by the maintenance of physical activity levels in the SHIFT arm and a decline in physical activity levels in the control arm. Favourable differences at 6 months were also seen in the SHIFT arm, relative to the control arm, in time spent sitting, standing and stepping, and time in moderate or vigorous activity. No differences between arms were observed at 16–18 months’ follow-up. No differences were observed between arms in the other secondary outcomes at either follow-up (i.e. 6 months and 16–18 months). The process evaluation demonstrated that the intervention was well received by participants and that the intervention reportedly had a positive impact on their health behaviours. The average total cost of delivering the SHIFT programme was £369.57 per driver, and resulting quality-adjusted life-years were similar across trial arms (SHIFT arm: 1.22, 95% confidence interval 1.19 to 1.25; control arm: 1.25, 95% confidence interval 1.22 to 1.27).

Limitations

A higher (31.4%) than anticipated loss to follow-up was experienced at 6 months, with fewer (54.7%) participants providing valid primary outcome data at 6 months. The COVID-19 pandemic presents a major confounding factor, which limits our ability to draw firm conclusions regarding the sustainability of the SHIFT programme.

Conclusion

The SHIFT programme had a degree of success in positively impacting physical activity levels and reducing sitting time in heavy goods vehicle drivers at 6-months; however, these differences were not maintained at 16–18 months.

Future work

Further work involving stakeholder engagement is needed to refine the content of the programme, based on current findings, followed by the translation of the SHIFT programme into a scalable driver training resource.

Trial registration

This trial is registered as ISRCTN10483894.

Funding

This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 12. See the NIHR Journals Library website for further project information.

The effectiveness of the Structured Health Intervention For Truckers (SHIFT): a cluster randomised controlled trial (RCT)

BACKGROUND

Long distance heavy goods vehicle (HGV) drivers exhibit higher than nationally representative rates of obesity, and obesity-related co-morbidities, and are underserved in terms of health promotion initiatives. The purpose of this study was to evaluate the effectiveness of the multicomponent 'Structured Health Intervention For Truckers' (SHIFT), compared to usual care, at 6- and 16-18-month follow-up.

METHODS

We conducted a two-arm cluster RCT in transport sites throughout the Midlands, UK. Outcome measures were assessed at baseline, at 6- and 16-18-month follow-up. Clusters were randomised (1:1) following baseline measurements to either the SHIFT arm or usual practice control arm. The 6-month SHIFT programme included a group-based interactive 6-h education and behaviour change session, health coach support and equipment provision (Fitbit® and resistance bands/balls to facilitate a 'cab workout'). The primary outcome was device-assessed physical activity (mean steps/day) at 6 months. Secondary outcomes included the following: device-assessed sitting, physical activity intensity and sleep; cardiometabolic health, diet, mental wellbeing and work-related psychosocial variables. Data were analysed using mixed-effect linear regression models using a complete-case population.

RESULTS

Three hundred eighty-two HGV drivers (mean ± SD age: 48.4 ± 9.4 years, BMI: 30.4 ± 5.1 kg/m², 99% male) were recruited across 25 clusters (sites) and randomised into either the SHIFT (12 clusters, n = 183) or control (13 clusters, n = 199) arms. At 6 months, 209 (55%) participants provided primary outcome data. Significant differences in mean daily steps were found between groups, in favour of the SHIFT arm (adjusted mean difference: 1008 steps/day, 95% CI: 145-1871, p = 0.022). Favourable differences were also seen in the SHIFT group, relative to the control group, in time spent sitting (- 24 mins/day, 95% CI: - 43 to - 6), and moderate-to-vigorous physical activity (6 mins/day, 95% CI: 0.3-11). Differences were not maintained at 16-18 months. No differences were observed between groups in the other secondary outcomes at either follow-up.

CONCLUSIONS

The SHIFT programme led to a potentially clinically meaningful difference in daily steps, between trial arms, at 6 months. Whilst the longer-term impact is unclear, the programme offers potential to be incorporated into driver training courses to promote activity in this at-risk, underserved and hard-to-reach essential occupational group.

TRIAL REGISTRATION

ISRCTN10483894 (date registered: 01/03/2017).

The Impact of HIV-Associated Neurocognitive Impairment on Driving Performance in Commercial Truck Drivers

Driving ability can be diminished amongst people with HIV with associated neurocognitive impairment (NCI). We explore the relationship between HIV status, NCI and driving ability in professional truck drivers. Forty male professional drivers (20 HIV-positive; mean age = 39.20 ± 7.05) completed a neuropsychological test battery, two driving simulator tasks that assessed driving ability, and a driving history and habits questionnaire. A higher proportion of HIV-positive drivers exhibited impaired overall cognitive performance (p ≤ 0.001). Overall, drivers with NCI (defined as z ≤ 1.00) were more likely than those without NCI to crash (p = 0.002). There were no significant between-group (HIV-positive versus HIV-negative) differences with regard to self-reported on-road driving events. Professional drivers with NCI, as measured on a driving simulator, are at increased risk of making driving errors under high-risk conditions compared to their neurocognitively normal counterparts. These data should inform driver health management with regard to annual medical screening and surveillance.

Cardiometabolic risk factors and mental health status among truck drivers: a systematic review

OBJECTIVE

This study aimed to systematically review and summarise the literature on cardiometabolic risk factors, lifestyle health behaviours and mental health status of truck drivers globally to ascertain the scale of these health concerns.

DESIGN

Systematic review reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

DATA SOURCES

PubMed, Scopus, PsycINFO and Web of Science were searched in January 2019 and updated in January 2020, from the date of inception to 16 January 2020.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Papers were included if they (1) reported independent data on truck drivers, (2) included quantitative data on outcomes related to cardiometabolic markers of health, mental health and/or health behaviours, (3) were written in English and (4) were published in a peer-reviewed journal. Grey literature was ineligible for this review.

DATA EXTRACTION AND SYNTHESIS

One reviewer independently extracted data and assessed methodological quality using a checklist based on the National Heart, Lung and Blood Institute Quality Assessment tool. 20% were independently assessed for eligibility and quality by a second reviewer. Due to heterogeneity of the outcomes, results were narratively presented.

RESULTS

3601 titles and abstracts were screened. Seventy-three studies met the inclusion criteria. Truck driving is associated with enforced sedentarism, long and irregular working hours, lack of healthy foods, social isolation and chronic time pressures. Strong evidence was observed for truck drivers to generally exhibit poor cardiometabolic risk profiles including overweight and obesity, hypertension, hypercholesterolaemia, high blood glucose, poor mental health and cigarette smoking.

CONCLUSIONS

Improving truck driver health is vital for the longevity of the trucking industry, and for the safety of all road users. The workplace plays a vital role in truck driver health; policies, regulations and procedures are required to address this health crisis.

PROSPERO REGISTRATION NUMBER

CRD42019124499.

Cancer risk in road transportation workers: a national representative cohort study with 600,000 person-years of follow-up

We analysed cancer risk in road transportation workers (RTWs) exposed to traffic air pollution and motor vehicle engine exhaust using the Korean National Health Insurance Service database. RTWs were defined as individuals in the transportation workers group doing road transportation. First admission history of cancer within a 3-year wash-out period was defined as an incident case. The crude incidence, standardised incidence ratio (SIR), and 95% confidence interval (CI) of all cancer risk of RTWs were compared with those of government employees or the whole working population. In total, 3,074 cancer cases were found among RTWs. The respective SIRs and 95% CIs for cancers in RTWs compared with those in the whole population were as follows: liver and intrahepatic bile duct cancers, 1.15 and 1.04-1.27; other digestive organ cancers, 1.28 and 1.04-1.57; trachea, bronchus, and lung cancers, 1.28 and 1.15-1.43; and bladder cancer, 1.26 and 1.03-1.52, respectively. The corresponding SIRs and 95% CIs were also higher in RTWs than in government employees. RTWs have a high risk of developing cancer, including cancer in the liver, intrahepatic bile ducts, other digestive organs, trachea, bronchus, lung, and bladder. Our results can assist in establishing prevention strategies for various cancers in RTWs.

Prevalence, awareness, and determinants of type 2 diabetes mellitus among commercial taxi drivers in buffalo city metropolitan municipality South Africa: A cross-sectional survey

Undiagnosed type 2 diabetes mellitus constitutes a significant threat to the health of commercial taxi drivers, safety of the passengers and other road users. This study determines the prevalence of pre-diabetes and type 2 diabetes mellitus among commercial taxi drivers in Buffalo City Metropolitan Municipality (BCMM), Eastern Cape and examines the factors associated with type 2 diabetes mellitus.A cross-sectional survey of 403 commercial taxi drivers was undertaken using the World Health Organization (WHO) STEPwise approach. Anthropometric, blood pressure, and blood glucose measurements followed standard procedure. Diabetes status was determined using the fasting blood glucose (FBG) test. Diabetes was defined as a FBG ≥7.0mmol/L or self-reported history of diabetes or current diabetes medication use (treatment), while pre-diabetes was defined as a FBG of 5.6 to 6.9 mmol/L. Awareness of diabetes was defined as a self-reported history of diabetes.The mean age of the study participants was 43.3 ± 12.5years. Prevalence of pre-diabetes and diabetes were 17% (95% CI: 13.4-20.6) and 16% (95% CI: 12.4-19.6), respectively. Of those who had diabetes (n = 63), the majority were aware of their diabetes status (n = 43) and were on treatment (n = 30). In the unadjusted logistic regression, age, ever married, hypertension, obesity, and driving for more than 5 years were independently associated with diabetes. However, only age >35 (adjusted odds ratio [AOR]= 3.65, CI: 1.17-11.32), ever married (AOR= 3.26, CI: 1.52-6.99) and hypertension (AOR= 3.23, CI: 1.56-6.69) were associated with diabetes in the adjusted logistic regression model.The prevalence of diabetes among commercial taxi drivers in this study is high, almost twice the national prevalence of diabetes in South Africa. Periodic health screening among this sub-population group is important to bridge the gap of undiagnosed diabetes in South Africa.

Work stress and health problems of professional drivers: a hazardous formula for their safety outcomes

Background

Several empirical studies have shown that professional drivers are a vulnerable occupational group, usually exposed to environmental stressors and adverse work conditions. Furthermore, recent studies have associated work-related stress with negative job performances and adverse health outcomes within this occupational group, including cardiovascular diseases and unsafe vehicle operation.

Objective

The aim of this study was to describe the working conditions and the health status of this occupational group, and to evaluate the association between the Demand-Control model of job stress and their self-reported health and safety outcomes.

Methods

A pooled sample of 3,665 Colombian professional drivers was drawn from five different studies. The Job Content Questionnaire and the General Health Questionnaire were used to measure work stress and self-reported mental health, respectively. Additionally, professional drivers self-reported health problems (hypertension, dyslipidemia, diabetes and overweight) and health-related risky behaviors (smoking and sedentary behavior).

Results

Regarding the Job Demands-Control (JDC) model, it was found that approximately a third part of Colombian professional drivers suffer from high job strain (29.1%). Correlational and multivariate analyses suggest that de JDC model of stress is associated with the professional drivers' mental health, traffic accidents and fines, but not with other physical and behavioral health-related outcomes, which are highly prevalent among this occupational group, such as hypertension, dyslipidemia, diabetes, overweight, smoking and sedentary behavior.

Conclusion

The results of this study suggest that (a) stressful working conditions are associated with health and lifestyle-related outcomes among professional drivers, and (b) that evidence-based interventions are needed in order to reduce hazardous working conditions, job stress rates and their negative impact on the health of this occupational group.

Sleep and Mental Health in Truck Drivers: Descriptive Review of the Current Evidence and Proposal of Strategies for Primary Prevention

Background: Professional truck drivers (TDs) are exposed to stressful working (and living) conditions and are vulnerable. They report physical and mental health problems and psychological distress more frequently than the general population and their problems can affect safety on the roads. Actions to improve TDs’ health and reduce the risks of (co-)morbidity or unsafe driving are imperative. Methods: The published studies dealing with the TDs’ sleep habits and mental health were reviewed to define the scenario and organize the preventive strategies proposed thus far. Results: Awareness among TDs of the high risk for health and safety due to (often co-existing) untreated sleep and mental health problems is critical. Alcohol and prescribed or illicit drugs are often misused to compensate for depression, anxiety, job strain, fatigue, and social isolation. Polypharmacy and dependence increase the chance of unsafe behaviors on the road. The TDs’ access to healthcare services is scant, and participation in industry-sponsored wellness programs is limited. Conclusions: Primary prevention is a first unavoidable step to deal with sleep and mental health problems. Educational programs, online support and tele-health assessment/monitoring would help improve the well-being, safety and health of professional TDs and increase safety on the road.

Cardiovascular disease risk differences between bus company employees and general workers according to the Korean National Health Insurance Data

Background

Bus drivers are known to be highly at risk of cardiovascular diseases. In this study, we assessed the cardiovascular disease prevalence of bus company employees in Seoul, South Korea, and compared the results to those of general workers.

Methods

We analyzed the 2014 Korean National Health Insurance (NHI) data and defined hypertension, diabetes, dyslipidemia, ischemic heart disease, and cerebrovascular disease based on the KCD-6 medical diagnoses. We used bus company employees as surrogate participants of bus drivers due to the characteristics of Korean NHI data. We identified bus company employees in Seoul based on one’s workplace which the insurance is registered. The prevalence of five diseases was compared between the bus company employees and general workers. We also calculated the odds ratios (OR) of five diseases between the bus company employees and general workers. To compensate the vast demographical differences between the two groups, we performed propensity score matching.

Results

Bus company employees have higher OR for having hypertension (OR 1.33, 95% CI: 1.28–1.39), diabetes mellitus (1.14, 95% CI: 1.08–1.22), and dyslipidemia (1.23, 95% CI: 1.17–1.29) than the general workers or propensity score matched controls. However, the OR of having ischemic heart disease were not significant. The OR of cerebrovascular disease were lower in bus company employees than in the general workers after adjusting the covariates, but similar in the propensity score matched model.

Conclusion

This study showed that the ORs of cardiovascular disease risk factors are high in bus company employees when compared to the general working population. Further studies with the longitudinal design should be conducted to confirm the causal association.

Occupation and Obstructive Sleep Apnea: A Meta-Analysis

OBJECTIVE

Obstructive sleep apnea (OSA) remains a prevalent condition, but its occupational burden is unclear. We carried out a systematic review to characterize the consistency and magnitude of occupational associations with OSA.

METHODS

We studied OSA within three occupational categories: commercial drivers, organic solvent-exposed workers, other selected occupations. We performed a meta-analysis on the prevalence of OSA among drivers and the risk of OSA associated with solvent exposure.

RESULTS

The pooled OSA prevalence in drivers was 41% (95% confidence interval [CI] 26% to 56%) for apnea hypopnea-index (AHI) is greater than 5, and 15% (95% CI 12% to 19%) for AHI is greater than 15. Exposure to solvents was associated with increased but non-statistically significant risk of OSA: summary relative risk, 2.38 (95% CI 0.89 to 6.32). Evidence of occupational association was inconsistent for other factors.

CONCLUSIONS

OSA is common among commercial drivers and potentially associated with occupations involving likely solvent exposure.

Conceptualising paediatric health disparities: a metanarrative systematic review and unified conceptual framework

OBJECTIVE

There exists a paucity of work in the development and testing of theoretical models specific to childhood health disparities even though they have been linked to the prevalence of adult health disparities including high rates of chronic disease. We conducted a systematic review and thematic analysis of existing models of health disparities specific to children to inform development of a unified conceptual framework.

METHODS

We systematically reviewed articles reporting theoretical or explanatory models of disparities on a range of outcomes related to child health. We searched Ovid Medline In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus (database inception to 9 July 2015). A metanarrative approach guided the analysis process.

RESULTS

A total of 48 studies presenting 48 models were included. This systematic review found multiple models but no consensus on one approach. However, we did discover a fair amount of overlap, such that the 48 models reviewed converged into the unified conceptual framework. The majority of models included factors in three domains: individual characteristics and behaviours (88%), healthcare providers and systems (63%), and environment/community (56%), . Only 38% of models included factors in the health and public policies domain.

CONCLUSIONS

A disease-agnostic unified conceptual framework may inform integration of existing knowledge of child health disparities and guide future research. This multilevel framework can focus attention among clinical, basic and social science research on the relationships between policy, social factors, health systems and the physical environment that impact children's health outcomes.

Rating the certainty in evidence in the absence of a single estimate of effect

When studies measure or report outcomes differently, it may not be feasible to pool data across studies to generate a single effect estimate (ie, perform meta-analysis). Instead, only a narrative summary of the effect across different studies might be available. Regardless of whether a single pooled effect estimate is generated or whether data are summarised narratively, decision makers need to know the certainty in the evidence in order to make informed decisions. In this guide, we illustrate how to apply the constructs of the GRADE (Grading of Recommendation, Assessment, Development and Evaluation) approach to assess the certainty in evidence when a meta-analysis has not been performed and data were summarised narratively.

Truck drivers' perceptions on wearable devices and health promotion: a qualitative study

Background

Professional truck drivers, as other shift workers, have been identified as a high-risk group for various health conditions including cardiovascular disease, obesity, diabetes, sleep apnoea and stress. Mobile health technologies can potentially improve the health and wellbeing of people with a sedentary lifestyle such as truck drivers. Yet, only a few studies on health promotion interventions related to mobile health technologies for truck drivers have been conducted. We aimed to explore professional truck drivers’ views on health promotion delivered via mobile health technologies such as wearable devices.

Methods

We conducted a phenomenological qualitative study, consisting of four semi-structured focus groups with 34 full-time professional truck drivers in the UK. The focus groups were audio-taped, transcribed verbatim and analysed using thematic content analysis. We discussed drivers’ perceptions of their health, lifestyle and work environment, and their past experience and expectations from mobile health technologies.

Results

The participants viewed their lifestyle as unhealthy and were aware of possible consequences. They expressed the need and wish to change their lifestyle, yet perceived it as an inherent, unavoidable outcome of their occupation. Current health improvement initiatives were not always aligned with their working conditions. The participants were generally willing to use mobile health technologies such as wearable devices, as a preventive measure to avoid prospect morbidity, particularly cardiovascular diseases. They were ambivalent about privacy and the risk of their employer’s monitoring their clinical data.

Conclusions

Wearable devices may offer new possibilities for improving the health and wellbeing of truck drivers. Drivers were aware of their unhealthy lifestyle. They were interested in changing their lifestyle and health. Drivers raised concerns regarding being continuously monitored by their employer. Health improvement initiatives should be aligned with the unique working conditions of truck drivers. Future research is needed to examine the impact of wearable devices on improving the health and wellbeing of professional drivers.

Repeated Cross-Sectional Assessment of Commercial Truck Driver Health

OBJECTIVE

To assess relationships and trends over time in individual conditions and multiple conditions among a large sample of independent, nonoverlapping truck drivers using a repeated cross-sectional study design.

METHODS

Commercial driver medical examinations were conducted on 95,567 commercial drivers between January 1, 2005, and October 31, 2012. Specific medical conditions that have been identified by the Federal Motor Carrier Safety Administration's Medical Review Board as possibly increasing crash risk were examined. Prevalence and trends over time were analyzed.

RESULTS

A total of 8 of the 13 conditions significantly increased from 2005 to 2012. Prevalence of multiple concomitant conditions also increased, with prevalence odds ratios as high as 7.39 (95% confidence interval, 3.92 to 13.98) for four or more conditions in 2012 as compared with 2005.

CONCLUSIONS

Individual and multiple conditions thought to be associated with increased crash risk significantly increased between 2005 and 2012.

Diabetes and collision risk. A meta-analysis and meta-regression

AIMS

The main objective of this study was to see whether diabetes is associated with an increased collision risk and to test the effect of age and gender on the overall collision risk for diabetes drivers.

MATERIALS AND METHODS

Twenty-eight studies were included in meta-analysis, using mean age, gender, continent and the prevalence of fatal road incidents as covariates.

RESULTS

The collision risk for diabetes drivers was small and not statistically significant - RR = 1.11 (1.01-1.23) with a prediction interval (PI) or 0.77-1.65. Age and gender were not associated with an increased overall risk. Insulin-dependent diabetes patients had a slightly increased effect size compared with the overall diabetes population, but the effect was not statistically significant. European diabetes drivers had a lower collision risk compared with their North American counterparts, the main cause being the difference of collision risk in the countries in which the studies were performed.

CONCLUSIONS

Overall, diabetes patients do not have a statistically significant increased risk for unfavourable traffic events. Old age and insulin-dependent patients tend to have a higher risk. Advances in diabetes care, associated with advances in road safety regulations, and automotive industry have not decreased significantly the collision risk in the last 50 years for drivers with diabetes.

Traffic Crash Risks in Morbidly Obese Drivers Before and After Weight Loss Surgery

Morbidly obese drivers have a higher risk of road crashes because of associated conditions such as obstructive sleep apnea. We assessed whether weight loss surgery has an impact on subsequent road crash risks in morbidly obese drivers. Our longitudinal self-matched cohort analyses suggest that road crash risks are three times higher in morbidly obese drivers than the population norm. Yet, weight loss surgery yields no significant reductions in crash risks. We found similar results in patients not previously diagnosed with sleep disorders, suggesting the need to clarify the relationship of obesity with road crash risk.

Commercial Driver Medical Examinations: Prevalence of Obesity, Comorbidities, and Certification Outcomes

Supplemental Digital Content is Available in the Text.

Objective:

The objective of this study was to assess relationships between body mass index (BMI) and comorbid conditions within a large sample of truck drivers.

Methods:

Commercial driver medical examination data from 88,246 commercial drivers between 2005 and 2012 were analyzed for associations between BMI, medical disorders, and driver certification.

Results:

Most drivers were obese (53.3%, BMI >30.0 kg/m²) and morbidly obese (26.6%, BMI >35.0 kg/m²), higher than prior reports. Obese drivers were less likely to be certified for 2 years and more likely to report heart disease, hypertension, diabetes mellitus, nervous disorders, sleep disorders, and chronic low back pain (all P < 0.0001). There are relationships between multiple potentially disqualifying conditions and increasing obesity (P < 0.0001). Morbid obesity prevalence increased 8.9% and prevalence of three or more multiple conditions increased fourfold between 2005 and 2012.

Conclusions:

Obesity is related to multiple medical factors as well as increasing numbers of conditions that limit driving certification.

Commercial Motor Vehicle Driver Obstructive Sleep Apnea Screening and Treatment in the United States: An Update and Recommendation Overview

ABSTRACT

No regulatory mandate exists in the United States (U.S.) for comprehensive obstructive sleep apnea (OSA) risk assessment and stratification for commercial motor vehicle (CMV) drivers. Current Federal Motor Carrier Safety Administration (FMCSA) requirements are outdated and depend largely on subjective report, a less reliable strategy in an occupational setting. Without FMCSA standards, sleep specialists, occupational medical examiners and employers rely on a collection of medical consensus recommendations to establish standards of care. These recommendations advise OSA risk assessment through a combination of focused medical history, physical examination, questionnaires, and accident history, which increase OSA detection compared to current FMCSA standards. For those diagnosed with OSA, consensus-based risk stratification helps identify CMV drivers who may benefit from OSA treatment and establish minimum standards for assessing treatment efficacy and adherence. Unfortunately no consolidated recommendation exists; rather, publications span medical and governmental literature in a patchwork fashion that no longer fully reflect current practice due to subsequent advances in OSA diagnosis, treatment, and technology. Based on searches of medical literature, internet materials, and reference lists from existing publications, an overview and discussion of key published recommendations regarding OSA assessment and treatment in CMV operators is provided. Suggestions for incorporating these recommendations into clinical sleep medicine practice in the U.S. are presented. The challenge for sleep specialists is maintaining the delicate balance between recommendations impacting standard of care and associated medico-legal impact with stakeholder interests from medical, regulatory, industry and public perspectives while providing high quality and efficient care.

Financial evaluations of antibiotic stewardship programs-a systematic review

Introduction: There is an increasing awareness to counteract problems due to incorrect antimicrobial use. Interventions that are implemented are often part of an Antimicrobial Stewardship Program (ASPs). Studies publishing results from these interventions are increasing, including reports on the economical effects of ASPs. This review will look at the economical sections of these studies and the methods that were used.

Methods: A systematic review was performed of articles found in the PubMed and EMBASE databases published from 2000 until November 2014. Included studies found were scored for various aspects and the quality of the papers was assessed following an appropriate check list (CHEC criteria list).

Results: 1233 studies were found, of which 149 were read completely. Ninety-nine were included in the final review. Of these studies, 57 only mentioned the costs associated with the antimicrobial medication. Others also included operational costs (n = 23), costs for hospital stay (n = 18), and/or other costs (n = 19). Nine studies were further assessed for their quality. These studies scored between 2 and 14 out of a potential total score of 19.

Conclusions: This review gives an extensive overview of the current financial evaluation of ASPs and the quality of these economical studies. We show that there is still major potential to improve financial evaluations of ASPs. Studies do not use similar nor consistent methods or outcome measures, making it impossible draw sound conclusions and compare different studies. Finally, we make some recommendations for the future.

Narrative reviews

Although qualitative researches (QR) are invaluable in understanding complex healthcare situations, the quantitative systematic reviews could not treat them. To improve quality of healthcare services, results of QR should be considered in healthcare decision-making processes. Several methods and theories for synthesizing evidences of QR have been developed. In order to activate the narrative reviews and mixed methods reviews in Korean healthcare academies, I arranged the related nomenclatures and suggested some issues to conduct them.