Psychoactive Substance Use and the Risk of Motor Vehicle Crash Injuries in Southern Taiwan

The purpose of this study was to examine the association between psychoactive drug use and motor vehicle crash (MVC) injuries requiring hospitalization in southern Taiwan. A case–control study was conducted in southern Taiwan from January 2009 to December 2009. The cases included car or van drivers who were involved in MVCs and required hospitalization. Demographic and trauma-related data were collected from questionnaires and hospital and ambulance records. Urine and/or blood samples were collected on admission. The controls consisted of drivers who were randomly recruited while driving on public roads. Study subjects were interviewed and asked to provide urine samples. All blood and urine samples were tested for alcohol and a number of other legal and illegal drugs. Only those subjects who provided urine and/or blood specimens were included in the study. During the study period, 254 case patients and 254 control drivers were enrolled. The analysis showed an odds ratio (OR) of 3.41 (95% confidence intervals (95% CI), 1.76–6.70; p < 0.001) for persons taking benzodiazepines, and an OR of 3.50 (95% CI, 1.81–6.85; p < 0.001) for those taking alcohol (blood alcohol concentrations (BAC) ≥ 0.8 g/l) with regard to hospitalizations due to MVCs. For persons taking combinations of benzodiazepines and alcohol, the OR increased to 5.12 (95% CI: 1.77–15.91, p < 0.001). This study concluded that drug use among motor vehicle drivers increases the risk of MVCs that require hospitalization. From a public health perspective, the high risk ratios are concerning, and preventive measures are warranted.     

Children with Special Physical Health Care Needs: Restraint Use and Injury Risk in Motor Vehicle Crashes

Physical disabilities may affect a child passenger’s fit within a conventional motor vehicle restraint. The aim of this study is to describe and compare injury risk in motor vehicle crashes (MVC) among children with and without special physical health care needs (SPHCN). This analysis, conducted in 2007–2008, utilizes data collected between December 1998 and November 2002 in a cross-sectional study of children ≤15 years old involved in crashes of State-Farm insured vehicles in 15 states and the District of Columbia. Parent reports via telephone survey were used to define pre-crash SPHCN, restraint status, and occurrence of significant injuries using a validated survey. Complete data were collected for 18,852 children aged 0–15 years; 159 children were reported to have a SPHCN (0.8% and 0.7% of children aged 0–8 and 9–15 years, respectively). A greater proportion of children with SPHCN aged 0–8 years were appropriately restrained (P < 0.001), but there was no significant difference in restraint use among children with and without SPHCN aged 9–15 years. There was no significant association between the presence of a SPHCN and injury risk in either age group, after adjustment for child/driver characteristics (children aged 0–8 years: OR 1.27, 95% CI: 0.48–3.33; children aged 9–15 years: OR 1.51, 95% CI: 0.38–6.11). Children with and without SPHCN have similar injury risk in MVC, despite increased age-appropriate restraint usage among children aged 0–8 years. When counseling families about vehicle safety, practitioners should consider the fit of a child with SPHCN in a restraint system.     

Adolescent and Young Adult Crash Risk: Sensation Seeking,Substance Use Propensity and Substance Use Behaviors

In a national youth sample, the propensity to use substances was more strongly related to motor vehicle crashes than use of any specific substance studied (cigarette, alcohol, marijuana). Substance use propensity was associated with sensation seeking, suggesting that increased crash risk for these youth is likely a result of general risk-taking tendencies.     

Medication Exposure in Pregnancy Risk Evaluation Program: The Prevalence of Asthma Medication Use During Pregnancy

Asthma is one of the most common chronic diseases in women of reproductive age, occurring in up to 8 % of pregnancies. The objective of this study is to assess the prevalence of asthma medication use during pregnancy in a large diverse cohort. We identified women aged 15–45 years who delivered a live born infant between 2001 and 2007 across 11 U.S. health plans within the Medication Exposure in Pregnancy Risk Evaluation Program (MEPREP). Using health plans’ administrative and claims data, and birth certificate data, we identified deliveries for which women filled asthma medications from 90 days before pregnancy through delivery. Prevalence (%) was calculated for asthma diagnosis and medication dispensing. There were 586,276 infants from 575,632 eligible deliveries in the MEPREP cohort. Asthma prevalence among mothers was 6.7 %, increasing from 5.5 % in 2001 to 7.8 % in 2007. A total of 9.7 % (n = 55,914) of women were dispensed asthma medications during pregnancy. The overall prevalence of maintenance-only medication, rescue-only medication, and combined maintenance and rescue medication was 0.6, 6.7, and 2.4 % respectively. The prevalence of maintenance-only use doubled during the study period from 0.4 to 0.8 %, while rescue-only use decreased from 7.4 to 5.8 %. In this large population-based pregnancy cohort, the prevalence of asthma diagnoses increased over time. The dispensing of maintenance-only medication increased over time, while rescue-only medication dispensing decreased over time.     

驾驶员饮酒与机动车道路伤害的关系

目的探讨驾驶员饮酒与机动车道路伤害之间的关系.方法采用病例对照研究方法,以2001年11月至2002年8月在沈阳市皇姑区发生机动车交通事故的驾驶员406例为病例,同期、同地区内于随机时间、随机道路上正常行驶的驾驶员438例为对照.采用统一的问卷对驾驶员进行面询,调查内容包括一般情况,发生事故前/调查时(对照)饮酒情况,进行呼出气酒精检测和血液乙醇定量检测.并对驾驶员、道路交通管理人员进行深入访谈,探讨酒后驾车的原因.结果酒后驾车发生道路伤害的危险性是未饮酒驾车的4.13倍(OR=4.13,95%CI1.66～10.28),随驾驶员饮酒量增大,发生道路伤害的危险性逐渐增高,呈剂量反应关系(趋势χ2=9.20,P＜0.05).饮啤酒后6h内驾车发生伤害事故的危险性增高(OR=1.72,95%CI0.67～4.42).驾驶员酒后驾车原因多为对饮酒后驾车的危害认识不足.结论饮酒后驾车是造成机动车道路伤害的危险因素.饮啤酒亦会增加道路伤害发生的危险性.为加强对酒后驾车的预防和控制,必须加强对机动车驾驶员的教育和管理,正确认识饮酒对驾驶安全的危险性.     

机动车驾驶员道路交通伤害的危险因素分析

目的 探讨机动车驾驶员道路交通伤害(RTI)的危险因素,为进一步预防和控制RTI提供科学依据.方法 通过广西壮族自治区公安厅交警总队收集柳州市2000-2009年的RTI数据,用SPSS 13.0统计软件对机动车驾驶员的性别、年龄、驾龄、各种交通行为等进行单因素和多因素非条件logistic回归分析.结果 多因素非条件logistic回归分析结果表明,疲劳驾车、酒后驾车、超速行驶及违章变更车道是机动车驾驶员RTI的主要危险因素,其OR值(95％ CI)分别为4.73(1.94～11.87)、9.89(5.52～36.45)、11.55(3.93～58.63)、3.78(1.94～7.85).结论 疲劳驾车、酒后驾车、超速行驶及违章变更车道与RTI密切相关.     

蓬莱市四轮机动车交通事故影响因素的非条件Logistic回归分析

[目的]探讨四轮机动车道路伤害中的危险因素,为进一步开展交通道路伤害预防提供科学依据。[方法]在蓬莱市随机抽取430名四轮车驾驶员,采用非条件Logistic回归方法分析四轮机动车交通事故危险因素的病例对照研究。[结果]多因素非条件Logistic回归分析结果,影响四轮机动车交通事故的因素有高年龄组、文化程度、伤害前2 h内喝浓茶、领驾照前正规训练时间、有车祸史、夜班、小型客车、大型货车、工人、管理人员。[结论]有车祸史、夜班是伤害的危险因素,文化程度高、领驾照前正规训练时间长是道路交通伤害的主要保护因素。     

Patterns and Consequences of Inadequate Sleep in College Students: Substance Use and Motor Vehicle Accidents

We examined college sleep patterns and consequences using a cross-sectional design. We found that students get insufficient sleep and frequently use medication and alcohol as sleep aids, use stimulants as alertness aids, and fall asleep at the wheel, or have motor vehicle accidents due to sleepiness. Future studies should focus on effective interventions for sleep in college students.     

Novice Drivers' Risky Driving Behavior, Risk Perception, and Crash Risk: Findings From the DRIVE Study

Objectives. We explored the risky driving behaviors and risk perceptions of a cohort of young novice drivers and sought to determine their associations with crash risk.Methods. Provisional drivers aged 17 to 24 (n = 20 822) completed a detailed questionnaire that included measures of risk perception and behaviors; 2 years following recruitment, survey data were linked to licensing and police-reported crash data. Poisson regression models that adjusted for multiple confounders were created to explore crash risk.Results. High scores on questionnaire items for risky driving were associated with a 50% increased crash risk (adjusted relative risk = 1.51; 95% confidence interval = 1.25, 1.81). High scores for risk perception (poorer perceptions of safety) were also associated with increased crash risk in univariate and multivariate models; however, significance was not sustained after adjustment for risky driving.Conclusions. The overrepresentation of youths in crashes involving casualties is a significant public health issue. Risky driving behavior is strongly linked to crash risk among young drivers and overrides the importance of risk perceptions. Systemwide intervention, including licensing reform, is warranted.The overrepresentation of youths in crashes involving casualties is a significant public health issue in most high-income countries.^1,2 As a result, prevention of crashes by novice drivers is a key focus for many jurisdictions, policymakers, and researchers. The introduction of graduated driver licensing, which gradually introduces full driving privileges for novice drivers, has brought about significant reductions in crashes, particularly in settings where more stringent conditions such as restrictions on passenger numbers and night driving have been introduced.^3,4 Research on novice drivers'' risky behaviors and risk perceptions is crucial to understanding how this initiative can be improved or how complementary interventions can be developed.There is much to be learned about the impact of novice drivers'' risky driving and how it is associated with their increased risk of crash. Recent research confirms that certain risky driving behaviors are more prevalent among younger drivers than older drivers, especially among men.^5–12 These include high-level speeding and speeding for the thrill of it,^6,11,13–16 following too closely to the vehicle ahead,⁵ violating traffic rules,⁹ not using seatbelts,^17–19 using mobile phones while driving^20–22 (including text messaging^23,24), driving during high-risk nighttime hours,^2,25,26 and driving older vehicles.^14,27,28In addition, certain driving behaviors have been demonstrated to be of higher risk for young novice drivers than for experienced adult drivers; these include carrying peer passengers or multiple passengers^2,29–32 and driving under the influence of alcohol, even at low concentrations.^26,33,34Paradoxically, given higher levels of risk taking, young drivers are often found to be more aware of driving risks than drivers of other age groups, particularly regarding alcohol,^18,35–39 although young males tend to have poorer perceptions of risk than females.^{6,35,37,39–41} Nonetheless, young people who undertake or are exposed to risky driving behaviors tend also to perceive driving risks as low.^15,35,39,42 In a prevalence study conducted recently in Australia, McEvoy et al. reported that those who reported mobile phone use while driving regarded a range of risky driving practices as significantly less dangerous than those who did not report phone use.⁴³Young people''s risk perceptions, however, can be dependent on context. For example, although speeding per se or under usual conditions is typically viewed as risky,^6,39 speeding on a clear, dry day is not.⁶ Driving fast because one is in a hurry is considered not as risky as driving fast to test a car''s speed, whereas racing other cars ranks among the highest perceived risks.³⁵ Likewise, studies have found that the general public considers only small excess rates of speed (64 km/h in a 60-km/h zone and 105 km/h in a 100-km/h zone) to be acceptable¹⁸ but that high school students of driving age accept higher speeds: in one study, one quarter of students accepted 70 km/h or more in a 60-km/h zone as safe and one quarter accepted 120 km/h or more in a 100-km/h zone as safe if conditions were good.³⁷ In another study, when asked how much over a 60 km/h speed limit a driver would have to be going to be considered “stupid,” young drivers reported a significantly higher speed threshold than older drivers, but there were no differences in reported thresholds for a driver to be considered “irresponsible” or “criminal.”⁶Differences in young drivers'' perceptions of other risks have also been found. For example, ratings of perceived risk have increased from very low when peer passengers are in the car to higher ratings when passengers have been drinking alcohol, smoking marijuana, or are not wearing seatbelts to highest ratings when passengers are trying to get the driver to speed or are acting wild.³⁵ Regarding driving while using a mobile phone, hands-free use has been considered less risky than manual use^18,44 and answering a call, dialing, or text messaging as more risky than talking on a phone.^35,45Such findings raise questions about whether risk perception and risky driving behaviors are strongly related and whether either is directly associated with crashes. Few recent studies of novice drivers have explored these issues, particularly the utility of either risk perception or risky driving behaviors for predicting the risk of a crash. An earlier study conducted in Australia found that self-reported risky driving behaviors were linked to increased risk of crashes in the first year of driving, but this study did not examine the impact of risk perception on crash risk.⁴⁶ Our aim was to explore the risky driving behaviors and risk perceptions of a cohort of young, newly licensed drivers and to determine the associations between these factors and crash risk.     

Acculturation,Income, Education,Safety Belt Use,and Fatal Motor Vehicle Crashes in California

This paper investigates the role that acculturation, income, and education play in safety belt nonuse among Californian drivers involved in fatal Motor Vehicle Crashes (MVCs). To achieve this goal, measures of acculturation, income, and education were stochastically incorporated into the Fatality Analysis Reporting System (FARS). Using the 1990 California Tobacco Survey and U.S. Census data, we estimated the combination of zip-code-based measures that most accurately predicts an individual, language-based acculturation index for Hispanics and Asians. Logistic regression was used to investigate the role of these variables in safety belt nonuse in fatal MVCs. We found that acculturation has a positive direct effect on safety belt use among Hispanics. We hypothesize that this positive direct effect is caused by Hispanic immigrants learning the benefits of wearing safety belts. However, our study also suggests an indirect negative effect of acculturation on safety belt use through drinking and driving. Prevention programs aimed at increasing the safety of Hispanic drivers not only need to take acculturation differences into account, but also need to be comprehensive in their message, simultaneously targeting both seat belt nonuse and drinking-and-driving problems.     

“风险管理计划”构建用药安全网

最近，一些药品生产企业．尤其是高风险品种生产企业，都在为一件事情而忙碌。造成这些企业纷纷整理资料．求助科研单位的原因是，国家食品药品监督管理局推出了《高风险品种“风险管理计划”》，该计划也拉开了我国药品风险管理体制构建序幕。     

机动车驾驶员职业禁忌证的研究

目的：为保障驾驶员安全与健康,制订健康检查标准及结果评定方法以及职业禁忌证。方法：由符合要求的专业人员,使用统一仪器,按规范方法参照WHO,公安部,卫生部规定的项目对33 195名驾驶员健康检查及对26562名学习驾驶员进行驾驶适应性检测,将结果统计分析,验证。结果：制订了有身高,远视力,色觉,血压,听力必查项目与有无妨碍驾驶安全或生理缺陷等检查项目及结果评定方法。结论：规定10个种类的职业禁忌证,并以“驾驶员健康检查及结果评定”作为上海市地方标准颁布。