1
|
Maxwell H, Dubois S, Cottrell-Martin E, Regalado SM, Stinchcombe A, Migay M, Gibbons C, Weaver B, Bédard M. The association between diabetes and safe driving: A systematic search and review of the literature and cross-reference with the current guidelines. Diabet Med 2023; 40:e15175. [PMID: 37422905 DOI: 10.1111/dme.15175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/21/2023] [Accepted: 07/04/2023] [Indexed: 07/11/2023]
Abstract
AIMS We conducted this review to characterize the quality of evidence about associations between diabetes and safe driving and to evaluate how these findings are reflected within current guidelines available to support clinicians and their patients with diabetes. METHODS The first stage entailed a systematic search and review of the literature. Evidence surrounding harms associated with diabetes and driving was identified, screened, extracted and appraised for quality utilizing the Newcastle Ottawa Scales (NOS). Next, relevant guidelines regarding driving and diabetes were sourced and summarized. Finally, the identified guidelines were cross-referenced with the results of the systematic search and review. RESULTS The systematic search yielded 12,461 unique citations; 52 met the criteria for appraisal. Fourteen studies were rated as 'high', two as 'medium' and 36 as 'low'. Studies with ratings of 'high' or 'medium' were extracted, revealing a body of inconsistent methods and findings. These results, cross-referenced with the guidelines, suggest a lack of agreement and a limited evidence base to justify recommendations. CONCLUSIONS The results presented emphasize the need for a better understanding of the impacts of diabetes on safe driving to inform evidence-based guidelines.
Collapse
Affiliation(s)
- Hillary Maxwell
- Centre for Applied Health Research, St. Joseph's Care Group, Thunder Bay, Ontario, Canada
- Centre for Research on Safe Driving, Lakehead University, Thunder Bay, Ontario, Canada
- Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
| | - Sacha Dubois
- Centre for Applied Health Research, St. Joseph's Care Group, Thunder Bay, Ontario, Canada
- Centre for Research on Safe Driving, Lakehead University, Thunder Bay, Ontario, Canada
- School of Nursing, Lakehead University, Thunder Bay, Ontario, Canada
- NOSM University, Thunder Bay, Ontario, Canada
| | - Elyse Cottrell-Martin
- Centre for Applied Health Research, St. Joseph's Care Group, Thunder Bay, Ontario, Canada
| | - Sophie M Regalado
- Centre for Applied Health Research, St. Joseph's Care Group, Thunder Bay, Ontario, Canada
- Centre for Research on Safe Driving, Lakehead University, Thunder Bay, Ontario, Canada
- NOSM University, Thunder Bay, Ontario, Canada
| | - Arne Stinchcombe
- Centre for Research on Safe Driving, Lakehead University, Thunder Bay, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Marcia Migay
- Centre for Applied Health Research, St. Joseph's Care Group, Thunder Bay, Ontario, Canada
| | - Carrie Gibbons
- Centre for Applied Health Research, St. Joseph's Care Group, Thunder Bay, Ontario, Canada
| | - Bruce Weaver
- Centre for Research on Safe Driving, Lakehead University, Thunder Bay, Ontario, Canada
| | - Michel Bédard
- Centre for Applied Health Research, St. Joseph's Care Group, Thunder Bay, Ontario, Canada
- Centre for Research on Safe Driving, Lakehead University, Thunder Bay, Ontario, Canada
- Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
| |
Collapse
|
2
|
Lees T, Chalmers T, Burton D, Zilberg E, Penzel T, Lal S. Psychophysiology of Monotonous Driving, Fatigue and Sleepiness in Train and Non-Professional Drivers: Driver Safety Implications. Behav Sci (Basel) 2023; 13:788. [PMID: 37887438 PMCID: PMC10603976 DOI: 10.3390/bs13100788] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/31/2023] [Accepted: 09/18/2023] [Indexed: 10/28/2023] Open
Abstract
Fatigue and sleepiness are complex bodily states associated with monotony as well as physical and cognitive impairment, accidents, injury, and illness. Moreover, these states are often characteristic of professional driving. However, most existing work has focused on motor vehicle drivers, and research examining train drivers remains limited. As such, the present study psychophysiologically examined monotonous driving, fatigue, and sleepiness in a group of passenger train drivers and a group of non-professional drivers. Sixty-three train drivers and thirty non-professional drivers participated in the present study, which captured 32-lead electroencephalogram (EEG) data during a monotonous driving task. Fatigue and sleepiness were self-evaluated using the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, the Karolinksa Sleepiness Scale, and the Checklist of Individual Strength. Unexpectedly, fatigue and sleepiness scores did not significantly differ between the groups; however, train drivers generally scored lower than non-professional drivers, which may be indicative of individual and/or industry attempts to reduce fatigue. Across both groups, fatigue and sleepiness scores were negatively correlated with theta, alpha, and beta EEG variables clustered towards the fronto-central and temporal regions. Broadly, these associations may reflect a monotony-associated blunting of neural activity that is associated with a self-reported fatigue state.
Collapse
Affiliation(s)
- Ty Lees
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA 16802, USA;
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Taryn Chalmers
- Medical Innovation Neuroscience Data-Analytics (MIND) Unit, TD School, University of Technology Sydney, Ultimo, NSW 2007, Australia;
| | - David Burton
- Compumedics Ltd., Melbourne, VIC 3067, Australia; (D.B.); (E.Z.)
| | - Eugene Zilberg
- Compumedics Ltd., Melbourne, VIC 3067, Australia; (D.B.); (E.Z.)
| | - Thomas Penzel
- Interdisciplinary Sleep Medicine Center, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany;
| | - Sara Lal
- Medical Innovation Neuroscience Data-Analytics (MIND) Unit, TD School, University of Technology Sydney, Ultimo, NSW 2007, Australia;
- Honorary, School of Psychology, Faculty of Science, University of New South Wales, Sydney, NSW 2052, Australia
- Honorary School of Public Heath, University of Technology Sydney, Sydney, NSW 2007, Australia
| |
Collapse
|
3
|
Gutiérrez-Abejón E, Criado-Espegel P, Pedrosa-Naudín MA, Fernández-Lázaro D, Herrera-Gómez F, Álvarez FJ. Trends in the Use of Driving-Impairing Medicines According to the DRUID Category: A Population-Based Registry Study with Reference to Driving in a Region of Spain between 2015 and 2019. Pharmaceuticals (Basel) 2023; 16:ph16040508. [PMID: 37111265 PMCID: PMC10145018 DOI: 10.3390/ph16040508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/24/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
The European DRUID (Drive Under the Influence of drugs, alcohol, and medicines) program classifies medications into three categories according to their effect on one’s fitness to drive. The trend in the use of driving-impairing medicines (DIMs) in a region of Spain between 2015 and 2019 was analyzed through a population-based registry study. Pharmacy dispensing records for DIMs are provided. The use of DIMs on drivers was weighted according to the national driver’s license census. The analysis was performed considering the population distribution by age and sex, treatment length, and the three DRUID categories. DIMs were used by 36.46% of the population and 27.91% of drivers, mainly chronically, with considerable daily use (8.04% and 5.34%, respectively). Use was more common in females than in males (42.28% vs. 30.44%) and increased with age. Among drivers, consumption decreases after 60 years of age for females and after 75 years of age for males. There was a 34% increase in the use of DIMs between 2015 and 2019, with a focus on daily use (>60%). The general population took 2.27 ± 1.76 DIMs, fundamentally category II (moderate influence on fitness to drive) (20.3%) and category III (severe influence on fitness to drive) (19.08%). The use of DIMs by the general population and drivers is significant and has increased in recent years. The integration of the DRUID classification into electronic prescription tools would assist physicians and pharmacists in providing adequate information to the patient about the effects of prescribed medications on their fitness to drive.
Collapse
|
4
|
Batson A, Newnam S, Koppel S. Examining Coroners' Recommendations for Health and Safety Management of Ageing Heavy Vehicle Drivers: A STAMP Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16112. [PMID: 36498186 PMCID: PMC9740677 DOI: 10.3390/ijerph192316112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/27/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
Recommendations were analysed from coronial cases involving ageing heavy vehicle drivers (≥55 years) and mapped onto a Systems Theoretic Accident Model and Processes (STAMP) control structure to identify the controllers and control actions influential in the heavy vehicle industry with regard to health and safety. A National Coronial Information System (NCIS) database search revealed 38 coroners' recommendations arising from 14 unique cases of ageing driver involvement. There were no ageing themes identified in the analysis of coroners' findings and recommendations. An examination of the STAMP control structure identified that the highest concentration of recommendations was in the level of regulation, the second most senior level of control, although safety constraints were advised for all five levels of the system. In regard to identifying themes of control flaws in the recommendations, the study found that "unidentified hazards" were the most common type of safety failure in the analysis of cases of ageing drivers, concentrated at the regulatory level, which indicates that additional risk identification methods by upper levels of control are needed. Therefore, a recommendation arising from the current study is that additional controls in safety intervention are necessitated in the upper and middle levels of the road freight transportation system; in particular, formalising health and safety education for organisational managers, with a focus on identifying ageing issues, would fill a gap in the system for managing ageing heavy vehicle drivers. In conclusion, this study has found that improving the health and safety of ageing heavy vehicle drivers necessitates additional safety constraints with a focus on formalised safety education for organisational managers, in addition to a means to detect emerging and unforeseen hazards in the road freight transportation industry.
Collapse
Affiliation(s)
- Angela Batson
- Monash University Accident Research Centre, Monash University, 21 Alliance Lane, Melbourne, VIC 3800, Australia
| | - Sharon Newnam
- School of Psychology and Counselling, Queensland University of Technology, Brisbane City, QLD 4000, Australia
| | - Sjaan Koppel
- Monash University Accident Research Centre, Monash University, 21 Alliance Lane, Melbourne, VIC 3800, Australia
| |
Collapse
|
5
|
Clemes SA, Varela-Mato V, Bodicoat DH, Brookes CL, Chen YL, Cox E, Edwardson CL, Gray LJ, Guest A, Johnson V, Munir F, Paine NJ, Richardson G, Ruettger K, Sayyah M, Sherry A, Paola ASD, Troughton J, Walker S, Yates T, King J. A multicomponent structured health behaviour intervention to improve physical activity in long-distance HGV drivers: the SHIFT cluster RCT. PUBLIC HEALTH RESEARCH 2022. [DOI: 10.3310/pnoy9785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Stacy A Clemes
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Institute for Health and Care Research Leicester Biomedical Research Centre, Leicester, UK
| | - Veronica Varela-Mato
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Institute for Health and Care Research Leicester Biomedical Research Centre, Leicester, UK
| | | | | | - Yu-Ling Chen
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Institute for Health and Care Research Leicester Biomedical Research Centre, Leicester, UK
| | - Edward Cox
- Centre for Health Economics, University of York, York, UK
| | - Charlotte L Edwardson
- National Institute for Health and Care Research Leicester Biomedical Research Centre, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Amber Guest
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Vicki Johnson
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Fehmidah Munir
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Institute for Health and Care Research Leicester Biomedical Research Centre, Leicester, UK
| | - Nicola J Paine
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Institute for Health and Care Research Leicester Biomedical Research Centre, Leicester, UK
| | | | - Katharina Ruettger
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Mohsen Sayyah
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Aron Sherry
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Institute for Health and Care Research Leicester Biomedical Research Centre, Leicester, UK
| | | | - Jacqui Troughton
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Simon Walker
- Centre for Health Economics, University of York, York, UK
| | - Thomas Yates
- National Institute for Health and Care Research Leicester Biomedical Research Centre, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - James King
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Institute for Health and Care Research Leicester Biomedical Research Centre, Leicester, UK
| |
Collapse
|
6
|
Batson A, Berecki-Gisolf J, Newnam S, Stathakis V. Pre-injury health status of truck drivers with a workers' compensation claim. BMC Public Health 2022; 22:1683. [PMID: 36064341 PMCID: PMC9446842 DOI: 10.1186/s12889-022-13885-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 07/25/2022] [Indexed: 11/10/2022] Open
Abstract
Truck drivers are a vulnerable population due to the high number of workplace injuries and fatalities predominant in their occupation. In Australia, the road freight transportation industry has been identified as a national priority area in terms of creating preventative measures to improve the health and safety of its workers. With an environment conducive to poor nutritional food choices and unhealthy lifestyle behaviours, many barriers exist to creating a safe and healthy workforce. Thus, the current study aimed to describe the pre-injury hospital-recorded health conditions and health service use of truck drivers with a worker’s injury compensation claim/s when compared to workers in other industries. Data was obtained from a compensation claims database and linked with hospital admissions data recorded five years prior to the injury claim. Health and lifestyle behaviour data for the occupational code of truck drivers was compared to other occupational drivers, as well as to all other occupations. Analysis was conducted via logistic regression. The results found that when compared to other occupational drivers, truck drivers were significantly more likely to have a hospital-recorded diagnosis of diabetes and/or hypertension, as well as being significantly more likely to have a hospital record of tobacco use and/or alcohol misuse/abuse. The findings show that there is a need to review and revise existing health strategies to promote the health and wellbeing of truck drivers, especially given their challenging work environment.
Collapse
Affiliation(s)
- Angela Batson
- Monash University Accident Research Centre, Monash University, 21 Alliance Lane, VIC, 3800, Australia.
| | - Janneke Berecki-Gisolf
- Monash University Accident Research Centre, Monash University, 21 Alliance Lane, VIC, 3800, Australia
| | - Sharon Newnam
- Queensland University of Technology, School of Psychology and Counselling, VIC, Australia
| | - Voula Stathakis
- Monash University Accident Research Centre, Monash University, 21 Alliance Lane, VIC, 3800, Australia
| |
Collapse
|
7
|
Electrophysiological Brain-Cardiac Coupling in Train Drivers during Monotonous Driving. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073741. [PMID: 33918480 PMCID: PMC8038250 DOI: 10.3390/ijerph18073741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/24/2021] [Accepted: 03/31/2021] [Indexed: 12/03/2022]
Abstract
Electrophysiological research has previously investigated monotony and the cardiac health of drivers independently; however, few studies have explored the association between the two. As such the present study aimed to examine the impact of monotonous train driving (indicated by electroencephalogram (EEG) activity) on an individual’s cardiac health as measured by heart rate variability (HRV). Sixty-three train drivers participated in the present study, and were required to complete a monotonous train driver simulator task. During this task, a 32 lead EEG and a three-lead electrocardiogram were recorded from each participant. In the present analysis, the low (LF) and high frequency (HF) HRV parameters were associated with delta (p < 0.05), beta (p = 0.03) and gamma (p < 0.001) frequency EEG variables. Further, total HRV was associated with gamma activity, while sympathovagal balance (i.e., LF:HF ratio) was best associated fronto-temporal delta activity (p = 0.02). HRV and EEG parameters appear to be coupled, with the parameters of the delta and gamma EEG frequency bands potentially being the most important to this coupling. These relationships provide insight into the impact of a monotonous task on the cardiac health of train drivers, and may also be indicative of strategies employed to combat fatigue or engage with the driving task.
Collapse
|
8
|
|
9
|
Population-Based Registry Analysis of Antidiabetics Dispensations: Trend Use in Spain between 2015 and 2018 with Reference to Driving. Pharmaceuticals (Basel) 2020; 13:ph13080165. [PMID: 32722515 PMCID: PMC7464462 DOI: 10.3390/ph13080165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 12/20/2022] Open
Abstract
Insulins and some oral antidiabetics are considered to be driving-impairing medicines (DIM) and they belong to the Driving under the Influence of Drugs, alcohol, and medicines (DRUID) category I (minor influence on fitness to drive). The trend of antidiabetics use in Castilla y León from 2015 to 2018 is presented through a population-based registry study. Treatment duration with these medicines and the concomitant use of other DIMs were observed. An adjustment method was used with information from the drivers' license census. For all calculations, age and gender were taken into account. 3.98% of the general population used at least one antidiabetic, as well as 2.92% of drivers. The consumption of antidiabetics in men was higher than in women (4.35% vs. 3.61%, p = 0.001), and the use increases with age, especially from 35-39 years to 75-79 years in men and 85-89 years in women. Antidiabetics were consumed chronically, specifically 100% in the case of insulins and 95% in the case of oral antidiabetics. In addition to antidiabetics, 2.5 ± 1.86 DIMs were consumed, mainly anxiolytics (25.53%), opioids (23.03%), other analgesics and antipiretics (19.13%), and antidepressants (17.73%). Collaboration between pharmacists and physicians is a priority to clearly transmitting risks to patients. It is necessary that the health authorities include information on DIMs, such as the DRUID classification, in the prescription and dispensing software.
Collapse
|
10
|
Useche SA, Cendales B, Alonso F, Montoro L. Multidimensional prediction of work traffic crashes among Spanish professional drivers in cargo and passenger transportation. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2020; 28:20-27. [PMID: 32276556 DOI: 10.1080/10803548.2020.1732102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The aim of this study was to examine the effect of different environmental, mechanical and individual factors associated with fatalities and serious injuries caused by work traffic accidents among cargo and passenger transport drivers (CPTD) in Spain. For this cross-sectional study, national data on work traffic accidents collected in Spain during the last 3 years were analyzed through a regression modeling approach, in order to predict the severity of traffic crashes involving CPTD. Using binary logistic regression analyses, it was found that the type of road and accident, the meteorological, light and vehicle conditions, individual characteristics and risky driving behaviors significantly predict the risk of fatal work traffic accidents and serious injuries. These findings highlight the importance of combining organizational efforts with national road safety policies in order to generate a traffic safety culture among CPTD.
Collapse
Affiliation(s)
| | - Boris Cendales
- Faculty of Economic and Administrative Sciences, El Bosque University, Colombia
| | | | | |
Collapse
|
11
|
Li AK, Nowrouzi-Kia B. Impact of Diabetes Mellitus on Occupational Health Outcomes in Canada. THE INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE 2017; 8:96-108. [PMID: 28432371 PMCID: PMC6679613 DOI: 10.15171/ijoem.2017.992] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 03/13/2017] [Indexed: 11/23/2022]
Abstract
Background: Research suggests that diabetes mellitus (DM) has a negative impact on employment and workplace injury, but there is little data within the Canadian context. Objective: To determine if DM has an impact on various occupational health outcomes using the Canadian Community Health Survey (CCHS). Methods: CCHS data between 2001 and 2014 were used to assess the relationships between DM and various occupational health outcomes. The final sample size for the 14-year study period was 505 606, which represented 159 432 239 employed Canadians aged 15–75 years during this period. Results: We found significant associations between people with diabetes and their type of occupation (business, finance, administration: 2009, p=0.002; 2010, p=0.002; trades, transportation, equipment: 2008, p=0.025; 2011, p=0.002; primary industry, processing, manufacturing, utility: 2013, p=0.018), reasons for missing work (looking for work: 2001, p=0.024; school or education: 2003, p=0.04; family responsibilities: 2014, p=0.015; other reasons: 2001, p<0.001; 2003, p<0.001; 2010, p=0.015), the number of work days missed (2010, 3 days, p=0.033; 4 days, p=0.038; 11 days, p<0.001; 24 days, p<0.001), and workrelated injuries (traveling to and from work: 2014, p=0.003; working at a job or business: 2009, p=0.021; 2014, p=0.001). Conclusion: DM is associated with various occupational health outcomes, including workrelated injury, work loss productivity, and occupation type. This allows stakeholders to assess the impact of DM on health outcomes in workplace.
Collapse
Affiliation(s)
- Anson Kc Li
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, Ontario, M5T 3M6, Canada
| | - Behdin Nowrouzi-Kia
- School of Rural and Northern Health, Centre for Research in Occupational Safety and Health, Laurentian University, 935 Ramsey Lake Rd, Sudbury, Ontario, P3E 2C6, Canada.
| |
Collapse
|
12
|
Meuleners L, Fraser ML, Govorko MH, Stevenson MR. Determinants of the occupational environment and heavy vehicle crashes in Western Australia: A case-control study. ACCIDENT; ANALYSIS AND PREVENTION 2017; 99:452-458. [PMID: 26643650 DOI: 10.1016/j.aap.2015.11.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 10/15/2015] [Accepted: 11/20/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To determine the association between a heavy vehicle driver's work environment, including fatigue-related characteristics, and the risk of a crash in Western Australia. METHODS This case-control study included 100 long-haul heavy vehicle drivers who were involved in a police-reported crash in WA and 100 long-haul heavy vehicle drivers recruited from WA truck stops, who were not involved in a crash in the previous 12 months. Driver demographics and driving details, work environment, vehicle and sleep-related characteristics were obtained using an interviewer-administered questionnaire. Drivers were tested for obstructive sleep apnoea using an overnight diagnostic device. Conditional multiple logistic regression analysis was undertaken to determine work environment-related factors associated with crash involvement. RESULTS After accounting for potential confounders, driving a heavy vehicle with an empty load was associated with almost a three-fold increased crash risk compared to carrying general freight (adjusted OR: 2.93, 95% CI: 1.17-7.34). Driving a rigid heavy vehicle was associated with a four-fold increased risk of crashing compared to articulated heavy vehicles (adjusted OR: 4.08, 95% CI: 1.13-14.68). The risk of crashing was almost five times higher when driving more than 50% of the trip between midnight and 5.59am (adjusted OR: 4.86, 95% CI: 1.47-16.07). Furthermore, the risk of crashing significantly increased if the time since the last break on the index trip was greater than 2h (adjusted OR: 2.18, 95% CI: 1.14-4.17). Drivers with more than 10 years driving experience were 52% less likely to be involved in a crash (adjusted OR: 0.48, 95% CI: 0.23-0.99). CONCLUSION The results provide support for an association between a driver's work environment, fatigue-related factors, and the risk of heavy vehicle crash involvement. Greater attention needs to be paid to the creation of a safer work environment for long distance heavy vehicle drivers.
Collapse
Affiliation(s)
- Lynn Meuleners
- Curtin-Monash Accident Research Centre (C-MARC), Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia.
| | - Michelle L Fraser
- Curtin-Monash Accident Research Centre (C-MARC), Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia
| | - Matthew H Govorko
- Curtin-Monash Accident Research Centre (C-MARC), Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia
| | - Mark R Stevenson
- Melbourne School of Design and Melbourne School of Engineering, The University of Melbourne, Melbourne, Victoria 3010, Australia
| |
Collapse
|
13
|
Thiese MS, Hanowski RJ, Kales SN, Porter RJ, Moffitt G, Hu N, Hegmann KT. Multiple Conditions Increase Preventable Crash Risks Among Truck Drivers in a Cohort Study. J Occup Environ Med 2017; 59:205-211. [PMID: 28079676 PMCID: PMC5293661 DOI: 10.1097/jom.0000000000000937] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This study aims to quantify the crash risk for truck drivers with multiple comorbid medical conditions, after adjusting for confounders. METHODS This retrospective cohort of 38,184 drivers evaluated concomitant medical conditions and subsequent crash data between January 1, 2005, and October 31, 2012. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were calculated for any cause and preventable crashes of varying severity. RESULTS Drivers with three or more medical conditions had a significantly increased risk of preventable Department of Transportation (DOT) reportable crashes (HR = 2.53, 95% CI = 1.65 to 3.88) and preventable crashes with injuries (HR = 2.23, 95% CI = 1.09 to 5.31) after adjustment for covariates. Similarly, adjusted HRs were 2.55 (95% CI = 1.37 to 4.73) for any cause DOT-reportable crashes and 3.21 (95% CI = 1.18 to 8.75) for any cause crashes with injuries. CONCLUSIONS Having three concomitant medical conditions may be a statistically significant risk factor for preventable and any cause DOT-reportable crashes and crashes with injuries.
Collapse
Affiliation(s)
- Matthew S. Thiese
- The Rocky Mountain Center for Occupational & Environment Health, Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Richard J. Hanowski
- Center for Truck and Bus Safety, Virginia Tech Transportation Institute, Blacksburg, Virginia, USA
| | - Stefanos N. Kales
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Massachusetts, Occupational Medicine, Cambridge Health Alliance/Harvard Medical School, Cambridge, Massachusetts, USA
| | - Richard J. Porter
- Department of Civil & Environmental Engineering, College of Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Gary Moffitt
- Arkansas Occupational Health Clinic, Springdale, Arkansas, USA
| | - Nan Hu
- Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Kurt T. Hegmann
- The Rocky Mountain Center for Occupational & Environment Health, Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
14
|
Brahem A, Selmi I, Boughattas W, Gaddour A, Maoua M, Kalboussi H, El Maalel O, Chatti S, Debbabi F, Mrizak N. Impact du diabète sur l’activité professionnelle : résultats d’une enquête réalisée dans un centre hospitalier à Sousse, Tunisie. ARCH MAL PROF ENVIRO 2016. [DOI: 10.1016/j.admp.2016.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
15
|
Abstract
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.
Collapse
Affiliation(s)
- S Hostiuc
- Department of Legal Medicine and Bioethics, Carol Davila University, Bucharest, Romania
- National Institute of Legal Medicine, Bucharest, Romania
| | - I Negoi
- Department of Surgery, Carol Davila University, Bucharest, Romania
| | - M Hostiuc
- Department of Internal Medicine and Gastroenterology, Carol Davila University, Bucharest, Romania
| |
Collapse
|
16
|
El-Menyar A, Mekkodathil A, Al-Thani H. Traumatic injuries in patients with diabetes mellitus. J Emerg Trauma Shock 2016; 9:64-72. [PMID: 27162438 PMCID: PMC4843569 DOI: 10.4103/0974-2700.179461] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Diabetes mellitus (DM) is associated with increased in-hospital morbidity and mortality in patients sustained traumatic injuries. Identification of risk factors of traumatic injuries that lead to hospital admissions and death in DM patients is crucial to set effective preventive strategies. We aimed to conduct a traditional narrative literature review to describe the role of hypoglycemia as a risk factor of driving and fall-related traumatic injuries. DM poses significant burden as a risk factor and predictor of worse outcomes in traumatic injuries. Although there is no consensus on the impact and clear hazards of hyperglycemia in comparison to the hypoglycemia, both extremes of DM need to be carefully addressed and taken into consideration for proper management. Moreover, physicians, patients, and concerned authorities should be aware of all these potential hazards to share and establish the right management plans.
Collapse
Affiliation(s)
- Ayman El-Menyar
- Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar; Department of Surgery, Trauma Surgery Section, Clinical Research, Hamad General Hospital, Doha, Qatar; Department of Internal Medicine, Ahmed Maher Teaching Hospital, Cairo, Egypt
| | - Ahammed Mekkodathil
- Department of Surgery, Trauma Surgery Section, Clinical Research, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| |
Collapse
|
17
|
Dømgaard M, Bagger M, Rhee NA, Burton CM, Thorsteinsson B. Individual and societal consequences of hypoglycemia: A cross-sectional survey. Postgrad Med 2015; 127:438-45. [PMID: 25971530 DOI: 10.1080/00325481.2015.1045815] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Hypoglycemia and fear of hypoglycemia threaten individuals' ability to work and drive. We studied the effect of hypoglycemia on the individual and society, with a focus on possible implications of new European union legislation on patients' continued ability to drive. METHODS A cross-sectional survey of Danish Diabetes Association members was conducted to investigate individual and societal consequences of hypoglycemia. RESULTS A total of 3117/9951 individuals with type 1 diabetes (T1DM) (32.2%) or type 2 diabetes (T2DM) (67.8%) completed the survey. The calculated incidence rates of self-reported severe and mild hypoglycemia were 2.9, 0.6 and 0.1 events per patient year (ppy) in patients with T1DM, insulin using T2DM and non-insulin using T2DM, respectively; and incidence rates of self-reported mild hypoglycemia were 99.0, 23.2 and 10.9 events ppy, respectively. Self-care strategies to avoid hypoglycemia include maintaining higher blood glucose levels (45.7%) and reducing physical activity (15.7%). Few people take sick leave as a result of hypoglycemia, but prolonged mental recovery ≥4 h following an episode of mild or severe hypoglycemia was reported by 8.7 and 31.0%, respectively. 26.5% of patients holding a valid driving license reported having ever had at least one episode of severe hypoglycemia. Patients considering underreporting of hypoglycemia to maintain their driving license were more likely to have experienced severe hypoglycemia (odds ratio [OR]: 3.03; 95% CI: 2.42-3.79; p < 0.0001). CONCLUSION A high proportion of insulin-treated patients experience hypoglycemia resulting in fear of hypoglycemia and changes in self-care behavior that may compromise glycemic control. Many patients with a history of severe hypoglycemia consider underreporting hypoglycemic events through concern over retaining their driving license.
Collapse
|
18
|
Kerr JL, Frichtl KD, Behnen EM. Diabetes management in Commercial Driver License holders. DIABETES EDUCATOR 2015; 41:231-40. [PMID: 25673426 DOI: 10.1177/0145721715569606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study is to evaluate diabetes management in Commercial Driver License (CDL) holders, how prescribing habits change when treating this patient population, and health care providers' knowledge of regulations concerning insulin use in CDL holders. METHODS A survey was posted on the American Association of Diabetes Educators (AADE) Communities of Interest websites and was open for 2 weeks. The anonymous survey collected demographic data and evaluated the perspectives of health care providers on diabetes management in CDL holders. Descriptive statistics were used to analyze the survey results. RESULTS A total of 139 AADE members responded to the survey, and 22.2% were prescribing providers. Findings from the survey indicated an overall lack of knowledge by health care professionals regarding the current laws affecting diabetes management in CDL holders. Most participants emphasized the need for making decisions on CDL suspension on a case-by-case basis, and some expressed concern that current laws may not be appropriate. CONCLUSION Additional diabetes education for health care providers who treat CDL holders is warranted as many health care providers were not familiar with current regulations and management strategies.
Collapse
Affiliation(s)
- Jessica L Kerr
- Southern Illinois University Edwardsville School of Pharmacy, Department of Pharmacy Practice, Edwardsville, Illinois (Dr Kerr, Dr Frichtl, Dr Behnen)
| | - Kelsey D Frichtl
- Southern Illinois University Edwardsville School of Pharmacy, Department of Pharmacy Practice, Edwardsville, Illinois (Dr Kerr, Dr Frichtl, Dr Behnen),Veterans Affairs Medical Center, Lincoln, Nebraska (Dr Frichtl)
| | - Erin M Behnen
- Southern Illinois University Edwardsville School of Pharmacy, Department of Pharmacy Practice, Edwardsville, Illinois (Dr Kerr, Dr Frichtl, Dr Behnen)
| |
Collapse
|
19
|
Abu Dabrh AM, Firwana B, Cowl CT, Steinkraus LW, Prokop LJ, Murad MH. Health assessment of commercial drivers: a meta-narrative systematic review. BMJ Open 2014; 4:e003434. [PMID: 24604478 PMCID: PMC3948638 DOI: 10.1136/bmjopen-2013-003434] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Motor vehicle accidents associated with commercial driving are an important cause of occupational death and impact public safety. OBJECTIVES We summarise the evidence regarding the type, prevalence and impact of medical conditions discovered during health assessment of commercial drivers. EVIDENCE REVIEW We conducted a systematic review of multiple electronic databases and made a manual search for relevant studies that enrolled commercial drivers in any country and reported the outcomes of health assessment carried out in the context of commercial driving through November 2012. Data were extracted by a pair of independent reviewers and synthesised using a metanarrative approach. RESULTS We identified 32 studies of moderate methodological quality enrolling 151 644 commercial drivers (98% men). The prevalence of multiple health conditions was high (sleep disorders 19%, diabetes 33%, hypertension 23% and obesity 45%). Some conditions, such as sleep disorders and obesity, were linked to increased risk of crashes. Evidence on several other highly relevant medical conditions was lacking. Cost-effectiveness data were sparse. CONCLUSIONS Several medical conditions are highly prevalent in commercial drivers and can be associated with increased risk of crashes, thus providing a rationale for health assessment of commercial drivers.
Collapse
Affiliation(s)
- Abd Moain Abu Dabrh
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Belal Firwana
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
- Department of Internal Medicine, University of Missouri, Columbia, Missouri, USA
| | - Clayton T Cowl
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Lawrence W Steinkraus
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Larry J Prokop
- Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohammad Hassan Murad
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
20
|
Lorber D, Anderson J, Arent S, Cox DJ, Frier BM, Greene MA, Griffin J, Gross G, Hathaway K, Hirsch I, Kohrman DB, Marrero DG, Songer TJ, Yatvin AL. Diabetes and driving. Diabetes Care 2014; 37 Suppl 1:S97-103. [PMID: 24357217 DOI: 10.2337/dc14-s097] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
21
|
Omer S, Dolan C, Dimitrov BD, Langan C, McCarthy G. General practitioners' opinions and attitudes towards medical assessment of fitness to drive of older adults in Ireland. Australas J Ageing 2013; 33:E33-6. [DOI: 10.1111/ajag.12045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sami Omer
- Sligo/Leitrim Mental Health Services; Sligo Ireland
- Department of Psychiatry; College of Medicine; University of Dammam; Dammam Saudi Arabia
| | | | - Borislav D Dimitrov
- HRB Centre for Primary Care Research; Department of General Practice; Royal College of Surgeons in Ireland; Dublin Ireland
- Academic Unit of Primary Care and Population Sciences; University of Southampton; Southampton UK
| | | | - Geraldine McCarthy
- Sligo/Leitrim Mental Health Services; Sligo
- Sligo Medical Academy; National University of Ireland; Galway Ireland
| |
Collapse
|
22
|
Signorovitch JE, Macaulay D, Diener M, Yan Y, Wu EQ, Gruenberger JB, Frier BM. Hypoglycaemia and accident risk in people with type 2 diabetes mellitus treated with non-insulin antidiabetes drugs. Diabetes Obes Metab 2013; 15:335-41. [PMID: 23121373 PMCID: PMC3593162 DOI: 10.1111/dom.12031] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 09/25/2012] [Accepted: 10/24/2012] [Indexed: 12/11/2022]
Abstract
AIMS To assess associations between hypoglycaemia and risk of accidents resulting in hospital visits among people with type 2 diabetes receiving antidiabetes drugs without insulin. METHODS People with type 2 diabetes who were not treated with insulin were identified from a US-based employer claims database (1998-2010). Following initiation of an antidiabetes drug, the occurrence of accidents resulting in hospital visits was compared between people with, and without, claims for hypoglycaemia using multivariable Cox proportional hazard models adjusted for demographics, comorbidities, prior treatments and prior medical service use. Additional analyses were stratified by age 65 years or older. RESULTS A total of N = 5582 people with claims for hypoglycaemia and N = 27,910 with no such claims were included. Accidents resulting in hospital visits occurred in 5.5 and 2.8% of people with, and without, hypoglycaemia, respectively. After adjusting for baseline characteristics, hypoglycaemia was associated with significantly increased hazards for any accident [hazard ratio (HR) 1.39, 95% CI 1.21-1.59, p < 0.001], accidental falls (HR 1.36, 95% CI 1.13-1.65, p < 0.001) and motor vehicle accidents (HR 1.82, 95% CI 1.18-2.80, p = 0.007). In age-stratified analyses, hypoglycaemia was associated with greater hazards of driving-related accidents in people younger than age 65 and falls in people aged 65 or older. CONCLUSIONS In people with type 2 diabetes receiving antidiabetes drugs without insulin, hypoglycaemia was associated with a significantly higher risk of accidents resulting in hospital visits, including accidents related to driving and falls.
Collapse
Affiliation(s)
- J E Signorovitch
- Health Economics and Outcomes Research, Analysis Group, Inc., Boston, MA 02199, USA.
| | | | | | | | | | | | | |
Collapse
|
23
|
Lorber D, Anderson J, Arent S, Cox DJ, Frier BM, Greene MA, Griffin JW, Gross G, Hathaway K, Kohrman DB, Marrero DG, Songer TJ, Yatvin AL. Diabetes and driving. Diabetes Care 2013; 36 Suppl 1:S80-5. [PMID: 23264427 PMCID: PMC3537281 DOI: 10.2337/dc13-s080] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
24
|
Lorber D, Anderson J, Arent S, J D, Frier BM, Greene MA, Griffin JW, Gross G, Hathaway K, Hirsch I, Kohrman DB, Marrero DG, Songer TJ, Yatvin AL. Diabetes and driving. Diabetes Care 2012; 35 Suppl 1:S81-6. [PMID: 22187475 PMCID: PMC3632177 DOI: 10.2337/dc12-s081] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
25
|
|
26
|
Martins DS. "Diabetes and literacy: negotiating control through artifacts of medicalization". THE JOURNAL OF MEDICAL HUMANITIES 2009; 30:115-130. [PMID: 19165582 DOI: 10.1007/s10912-009-9078-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
My experience with the California Department of Motor Vehicles offers a case to explore how bureaucratic institutions monitor, classify, and control individuals. By examining artifacts created for and used by the DMV through the lens of literacy studies, I discuss the variety of rhetorical strategies used in each document and the effects and implications of those strategies, for example on subjectivity or identity, and move beyond the language of the artifacts themselves to attend to how they are invested with power in the management and control of populations.
Collapse
Affiliation(s)
- David S Martins
- Department of English, California State University, Chico, Chico, CA 95929-0830, USA.
| |
Collapse
|
27
|
Lonnen KF, Powell RJ, Taylor D, Shore AC, MacLeod KM. Road traffic accidents and diabetes: insulin use does not determine risk. Diabet Med 2008; 25:578-84. [PMID: 18445171 DOI: 10.1111/j.1464-5491.2008.02409.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
AIMS Progressive restrictions placed on insulin-treated patients with diabetes exclude them from driving group 2 and class C1 and D1 vehicles. This reflects an assumption that an increased risk of hypoglycaemia in these patients will cause road traffic accidents. These restrictions have been implemented without any consistent evidence that this is the case. The aim of the study was therefore to investigate whether the rate of road traffic collisions in insulin-treated patients was higher than that of the non-diabetic population using a population register-based study. METHODS A historical cohort study combined information from the Devon and Cornwall Constabulary database on road traffic collisions with the district wide retinal screening database, to provide an anonymized matched database of road traffic collisions in the diabetic population. Accident rates were calculated in the diabetic population and compared to rates in the non-diabetic population using relative risks. RESULTS The estimated overall annual accident rate for the non-diabetic population was 1469 per 100,000 vs. 856 per 100,000 for the diabetic population as a whole (Chi-squared, P < 0.001). On stratification of the groups by age, within the insulin-treated group there was no significant difference in the accident rate compared to the non-diabetic population, with relative risks between 0.51 [confidence interval (CI) 0.25-1.05] and 1.13 (CI 0.88-1.46). CONCLUSIONS Our findings suggest that insulin-treated patients as a group do not pose an increased risk to road safety. They reiterate the need for an individualized risk-based assessment when considering driving restrictions.
Collapse
Affiliation(s)
- K F Lonnen
- Diabetes and Vascular Research, Institute of Biomedical and Clinical Science, Peninsula Medical School, Exeter, UK.
| | | | | | | | | |
Collapse
|
28
|
Stork ADM, van Haeften TW, Veneman TF. Diabetes and driving: Desired data, research methods and their pitfalls, current knowledge, and future research. Diabetes Care 2006; 29:1942-9. [PMID: 16873810 DOI: 10.2337/dc05-2232] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Alexander D M Stork
- Department of Internal Medicine and Metabolic Diseases, University Medical Center Utrecht, the Netherlands.
| | | | | |
Collapse
|
29
|
Ladwig J. Department of transportation examinations primary care: An intervention project. J Nurse Pract 2006. [DOI: 10.1016/j.nurpra.2006.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
30
|
Taylor AH, Dorn L. Stress, fatigue, health, and risk of road traffic accidents among professional drivers: the contribution of physical inactivity. Annu Rev Public Health 2006; 27:371-91. [PMID: 16533122 DOI: 10.1146/annurev.publhealth.27.021405.102117] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Strategies to achieve ambitious targets for reducing road accidents ( 34 ) have largely focused on engineering and technological advancements, the modification of occupational demands, and, to a lesser extent, human factors. These factors include stress and psychological states; sleep, fatigue, and alertness; and health status. Physical activity appears to influence all these human factors but has not previously been systematically considered as a direct or indirect risk factor for driver accidents. This chapter provides an overview, within an evidence-based framework, of the impact each of these human factors has on driver performance and risk of at-work road traffic accidents and then examines how physical (in)activity may moderate and mediate these relationships. Finally, we consider practical implications for work site interventions. The review aims to offer an evidence base for the deployment of resources to promote physical activity, manage stress, facilitate sleep, reduce fatigue, and enhance alertness to improve physical and psychological health among professional drivers.
Collapse
Affiliation(s)
- Adrian H Taylor
- School of Sport and Health Sciences, University of Exeter, Exeter, EX1 2LU, United Kingdom.
| | | |
Collapse
|
31
|
Aschkenasy MT, Drescher MJ, Ratzan RM. Physician reporting of medically impaired drivers. J Emerg Med 2006; 30:29-39. [PMID: 16434332 DOI: 10.1016/j.jemermed.2005.04.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2004] [Revised: 03/02/2005] [Accepted: 04/06/2005] [Indexed: 11/25/2022]
Abstract
Emergency physicians frequently encounter patients whose medical conditions represent a risk of loss of control while driving, e.g., epilepsy and diabetes. In certain states, physicians are under a legal obligation to report such drivers to the motor vehicular authorities. To determine the uniformity of legislated reporting requirements for physicians caring for patients whose medical conditions represent an automotive hazard, we conducted a survey of Department of Motor Vehicles (DMV) legal departments of all the states in the United States for the academic year 1999-2000 regarding physician reporting of patients with medical conditions that might predispose them to a motor vehicle crash (MVC) and compared the results to a similar study done in 1986. Six (12%) of the states had mandatory reporting laws, 25 (49%) had permissive reporting laws, and 20 (39%) had no laws regarding physician reporting. There was a significant difference between the distribution of laws by year. There was no uniformity on a national level concerning such legislation.
Collapse
Affiliation(s)
- Miriam T Aschkenasy
- Department of Emergency Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA
| | | | | |
Collapse
|
32
|
Sabbagh-Ehrlich S, Friedman L, Richter ED. Working conditions and fatigue in professional truck drivers at Israeli ports. Inj Prev 2005; 11:110-4. [PMID: 15805441 PMCID: PMC1730197 DOI: 10.1136/ip.2004.007682] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Trucks represent 6% of all vehicles, but truck crashes account for 20% of road deaths in Israel, even though travel distances are usually short (<200 km) and overnight travel is uncommon. OBJECTIVE To determine occupational and individual predictors of fatigue, falling asleep at the wheel, and involvement in crashes with injuries and deaths in truck drivers. SETTING AND METHODS We carried out field interviews of 160 port truck drivers regarding driver characteristics, workplace and driving conditions, employer-employee relations, medical conditions, sleep quality and fatigue, falling asleep at the wheel, and involvement in road crashes. RESULTS One day before interview, 38.1% of the drivers had worked more than the 12 hour legal limit. More than 30% reported falling asleep at the wheel recently, and 13% had prior involvement in a sleep related crash. Sixty seven (41.9%) drivers said that their employer forced them to work beyond the legal 12 hour daily limit. Involvement in a crash with casualties was associated with poor sleep quality (adjusted OR = 2.9; p = 0.042) and frequent difficulty finding parking when tired (OR = 3.7; p = 0.049). Self assessment of fatigue underestimated fatigue from the Pittsburgh Sleep Quality Questionnaire. However fatigue occurred in many drivers without sleep problems and many crashes occurred without fatigue. CONCLUSIONS Prevention requires measures to reduce work stresses, screening drivers, speed control, and modal shifts. The work risks and adverse outcomes of truck drivers in large countries with long overnight journeys occur in a small country with small distances, relatively short work journeys, and little overnight travel.
Collapse
Affiliation(s)
- S Sabbagh-Ehrlich
- Hebrew University-Hadassah School of Community Medicine and Public Health, Unit of Occupational and Environmental Medicine, Injury Prevention Center, Jerusalem 91120, Israel
| | | | | |
Collapse
|
33
|
Rémillard GM, Zifkin BG, Andermann F. Epilepsy and motor vehicle driving--a symposium held in Québec City, November 1998. Can J Neurol Sci 2002; 29:315-25. [PMID: 12463486 DOI: 10.1017/s0317167100002171] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND This report summarizes an invitational symposium on epilepsy and Canadian laws governing motor vehicle driving held in Québec City in November 1998. METHODS Invited neurological experts from Canada, the USA, and Europe; and representatives of provincial and territorial licensing bodies, the Canadian Council of Motor Transport Administrators, the Canadian Medical Protective Association, and the Canadian Medical Association participated. An edited version of transcribed audiotapes was prepared. Specific issues discussed were whether or not a physician should be required to report a patient with epilepsy to the licensing authority (mandatory reporting), the nature and quantification of the risks posed by epileptic drivers, and what would be a reasonable law regulating driving by people with epilepsy in Canada. RESULTS The consensus among medical experts was that mandatory reporting should be abolished in Canada and that a 6-12 month seizure-free period was appropriate before most patients could return to driving private cars. Experts also believed that these standards should be uniform across Canada. There was strong disagreement with the recommendation of the Canadian Medical Association that all such drivers be reported to provincial licensing authorities even in provinces without mandatory reporting rules. CONCLUSIONS Physicians should be familiar with and follow the rules regarding epilepsy and driving in the provinces where they practice. Nevertheless, current evidence is against mandatory physician reporting of drivers with epilepsy and the neurologists recommended that this be abolished throughout Canada. Shorter seizure-free intervals should also be considered before resuming driving of private cars.
Collapse
|