Prevalence of sleepiness in a group of Brazilian lorry drivers

OBJECTIVE: To determine the prevalence of sleepiness in a group of Brazilian lorry drivers. STUDY DESIGN: Cross-sectional study. METHODS: This study used a self-administrated questionnaire and the Epworth Sleepiness Scale (ESS). The questionnaire included questions regarding demographic features, professional data, sleep habits, night-time symptoms, excessive daytime sleepiness and history of previous automobile accidents. RESULTS: Four hundred and thirty-eight male drivers, aged 34.2+/-9.5 years (mean+/-SD), were included in the study. The mean number of hours spent driving each day was 9.2+/-2.6h, compared with 4.5+/-2.3h for the night shift. The median distance covered weekly was 1,200 km (range 70-6,000 km). The most common sleep complaints were insomnia (26.6%), loud snoring (45%) and witnessed apnoea (7.6%). Eighty-six of 392 (22%) drivers reported falling asleep while driving, and 11 (2.8%) subjects indicated falling asleep daily or almost daily. One hundred and seventy-one drivers (39%) had been involved in a traffic accident, and 21 of 128 drivers (16.4%) indicated sleepiness as a possible contributing factor. The ESS was higher than 10 points in 120 (28%) of the interviewees. CONCLUSIONS: Sleepiness is a prevailing symptom in lorry drivers and is probably related to accidents.     

机动车驾驶员道路交通伤害危险因素的病例对照研究

目的：探讨道路伤害中机动车驾驶员的危险因素，为进一步开展交通道路伤害预防提供科学依据。方法：采用病例对照研究方法，通过面询方法收集事故驾驶员和非事故驾驶员的一般情况、睡眠状况、急性困倦、吸烟、饮酒、违章驾驶行为等情况。以SPSS11．5软件进行统计分析。结果：调查了150名事故驾驶员和174名非事故驾驶员。在控制了其他影响因素情况下，驾驶时因感觉/判断错误、疏忽大意、遇紧急情况措施不当和违章操作的OR值（95％CI）分别是137．51（15．773-1198．876）、72．82（18．980-279．344）、25．16（3．097-204．398）和13．27（1．976-89．146）；初中及以下教育程度的驾驶员发生事故的危险性是高中及以上教育程度驾驶员的2．76倍（95％CI：1．082-7．021）；实际驾龄〈5年的驾驶员发生事故的危险性是实际驾龄≥5年的驾驶员的3．04倍（95％CI：1．235-7．457）；驾驶时感觉/判断失误与每周驾驶时间存在交互作用，每周驾驶时间≥40h的驾驶员，因感觉秽4断错误而发生交通事故的危险性低于每周驾驶时间〈40h的驾驶员（OR=0．022，95％CI：0．001-0．371）。结论：驾驶时疏忽大意、感觉/判断错误、遇紧急事故措施不当、违章操作、初中及以下教育程度、实际驾龄短是道路交通伤害中机动车驾驶员的危险因素。     

Prevalence and consequences of insomnia in New Zealand: disparities between Maori and non-Maori

OBJECTIVE: To investigate the prevalence of self-reported insomnia symptoms among Maori (Indigenous people) and non-Maori adults in the general population of New Zealand. To explore the consequences for health and quality of life experienced by those who report common insomnia complaints and sleeping problems. METHODS: In 2001, a two-page questionnaire was mailed to a stratified random sample of 4,000 adults aged 20-59 years nationwide. Participants were selected from the New Zealand electoral roll. The sample design aimed for equal numbers of Maori and non-Maori participants, men and women, and participants in each decade of age (72.5% response rate). RESULTS: Population prevalence estimates indicate that self-reported insomnia symptoms and sleeping problems are higher among Maori than non-Maori. Multiple logistic regression analyses showed that self-reported insomnia symptoms and/or sleeping problems are significantly associated with reporting poor or fair health and quality of life outcomes. CONCLUSIONS: Approximately one-quarter of adults in New Zealand may suffer from a chronic sleep problem, highlighting insomnia as a major public health issue in New Zealand. IMPLICATIONS: Significant differences in the prevalence of insomnia symptoms and current sleeping problems with respect to ethnicity have implications in the purchase and development of treatment services, with greater need for these services among Maori than non-Maori.     

驾驶员睡眠打鼾及日间嗜睡与交通事故关系

目的 调查睡眠打鼾与日间嗜睡对机动车驾驶员交通事故的影响.方法 对2006年9月11-15日在北京市朝阳区亚运村验车场5个工作日内前来验车驾驶员进行现场问卷调查.结果 共发放问卷1 002份,回收合格问卷988份.报告睡眠打鼾者133人,占13.50%;爱泼沃斯思嗜睡量表(Epworth Sleepiness Scale,ESS)评分≥9分者529人,占53.9%;报告曾发生追尾事故者346人,占35.02%;睡眠打鼾者与睡眠不打鼾者发生追尾事故分别为1.11次/人和0.62次/人,差异有统计学意义(P<0.01);且随着睡眠打鼾年数的增加,ESS评分的增高,发生追尾事故人均次数也随之增加.结论 睡眠打鼾且日间嗜睡者驾驶员发生交通事故风险较高,需进一步进行调查与干预.     

道路伤害的病例对照研究

目的：探讨道路伤害危险因素。方法：采用病例对照研究方法，于2001年11月至2002年8月收集沈阳市皇姑区发生机动车交通事故的事故组驾驶员406例，并同期在皇姑区内于随机时间、随机地点调查道路上正常行驶的对照组驾驶员438名。采用统一问卷、面询方法，调查内容包括驾驶员的一般情况，连续驾驶时间，事故／调查前睡眠状况，急、慢性困倦程度(采用Stanford和Epworth困倦量表测量)，饮酒，吸烟，驾驶安全态度和行为，车速，车辆状况等。结果：处于慢性困倦状态的驾驶员发生事故的危险性是非困倦状态驾驶员的1．98倍(OR=1．98，95％CI：1．26—3．12)，事故组驾驶员的困倦程度高于对照组，但差异无显著性(OR＝2．38，95％CI：0．89—6．31)。夜班或倒班发生事故的危险是常白班的2．09倍(OR＝2．09，95％CI：1．48—2．94)，酒后驾车发生事故的危险性是非酒后驾车的3．59倍(OR＝3．59，95％CI：1．13--11．39)，无人约束时会违章的驾驶员发生事故的危险性是不违章驾驶员的1．73倍(OR＝1．73，95％CI：1．22—2．46)。结论：慢性困倦、夜班或倒班、酒后驾车、违章等是道路伤害的危险因素，急性困倦可能是道路伤害的一个潜在危险因素。     

Breast cancer in Maori and non-Maori women.

BACKGROUND: Breast cancer is more common in Maori than in non-Maori women under the age of 40 years and is equally common in older women, despite Maori being generally of lower socioeconomic status and having had a higher fertility rate than non-Maori. METHODS: Data from a nationwide population-based case-control study of breast cancer in New Zealand women aged 25-54 years were used to compare the age-adjusted distribution of reproductive and other risk factors for breast cancer in self-identified Maori and non-Maori women from the control group. Separate analyses also were carried out for women aged 25-39 years and for those aged 40-54 years. The risk of breast cancer according to the proportion of Maori ancestry was estimated using multiple logistic regression simultaneously adjusting for several risk factors. RESULTS: Significant differences were found between self-identified Maori and non-Maori women in the age-adjusted frequencies for education level, socioeconomic status, age at first full-term pregnancy, parity, and duration of breastfeeding; the profile in all instances suggesting a lower risk of breast cancer for Maori than for non-Maori. There were no significant differences with respect to age at menarche, surgery for benign breast disease or a family history of breast cancer. Significantly more Maori than non-Maori were in the highest quartile of recent body mass index. Women self-identified as Maori has an approximately twofold higher risk of breast cancer than non-Maori women. CONCLUSIONS: Maori have high rates of breast cancer despite having a more favourable profile than non-Maori for most identified risk factors.     

Risky driving behaviour in young people: prevalence, personal characteristics and traffic accidents

OBJECTIVES: This research aimed to examine the prevalence of risky driving behaviour among young people, the characteristics of those who engage in risky driving behaviour, and the association between risky driving behaviours and accident risk. METHODS: Data were gathered during the course of the Christchurch Health and Development Study. As part of this longitudinal study, data were gathered on self-reported risky driving behaviours (18-21 years), traffic accidents (18-21 years) and a variety of individual characteristics for 907 participants who reported having driven a motor vehicle. RESULTS: More than 90% of drivers engaged in some form of risky driving behaviour. Those most likely to engage in frequent risky driving behaviours were: males (p < 0.0001), who exhibited alcohol (p < 0.0001) or cannabis abuse (p < 0.001) in adolescence, who were involved in violent/property crime (p < 0.01) and who affiliated with delinquent or substance-using peers (p < 0.05). There was a strong (p < 0.0001) association between the extent of risky driving behaviour and traffic accident risk. CONCLUSIONS: Risky driving behaviours are common among young people, particularly among young males prone to externalizing behaviours (substance abuse, crime and affiliations with deviant peers). Risky driving is strongly linked to traffic accident risk. IMPLICATIONS: There is a continued need to target risky driving behaviours among young people. Efforts to reduce risky driving should be targeted in particular at the high-risk group of young males prone to externalizing behaviours. More generally, the results suggest the need for a multistrategy approach to the reduction of traffic accidents that focuses on the full spectrum of risky driving behaviours.     

Does periodic vehicle inspection reduce car crash injury? Evidence from the Auckland Car Crash Injury Study

OBJECTIVES: This paper examines the association between periodic motor vehicle inspection and frequent tire pressure checks, and the risk of car crash injury. METHODS: Data were analysed from the Auckland Car Crash Injury Study, a population-based case-control study in Auckland, NZ, where vehicles are required to undergo six-monthly safety inspections. Cases were all cars involved in crashes in which at least one occupant was hospitalised or killed, which represented 571 drivers. Controls were randomly selected cars on Auckland roads (588 drivers). Participants completed a structured interview. RESULTS: Vehicles that did not have a current certificate of inspection had significantly greater odds of being involved in a crash where someone was injured or killed compared with cars that had a current certificate, after adjustment for age, sex, marijuana use, ethnicity and licence type (OR 3.08, 95% CI 1.87-5.05). Vehicles that had not had their tire pressure checked within the past three months also had significantly greater odds of being involved in a crash compared with those that had a tire pressure check, after adjustment for age, sex, ethnicity, seatbelt use, licence type, self-reported speed and hours per week of driving exposure (OR 1.89, 95% CI 1.16-3.08). CONCLUSIONS: This study provides new evidence, using rigorous epidemiological methods and controlling for multiple confounding variables, of an association between periodic vehicle inspections and three-monthly tire pressure checks and reduced risk of car crash injury. DISCUSSION: This research suggests that vehicle inspection programs should be continued where they already exist and contributes evidence in support of introducing such programs to other areas.     

A Preliminary Study of New Parents,Sleep Disruption,and Driving: A Population at Risk?

Background Drowsy driving is estimated to be a causal factor in 2–16 % of vehicular crashes. Several populations are reported to be at high risk for drowsy driving accidents, including shift workers, teenage drivers, medical residents, and pilots. Although new parents are known to have significant sleep disruption, no study has investigated vehicular accidents or near miss accidents in this population. Methods A preliminary cross-sectional, anonymous survey of parents who had given birth within the previous 12 months. Participants were asked about their sleep, including validated measures of sleep disruption, their driving patterns, and information about near miss traffic accidents and actual crashes. Results Overall, 72 participants were enrolled. A large proportion of participants had poor sleep including approximately 30 % with daytime sleepiness, 60 % with poor daytime function and two-thirds with poor sleep quality. The mean sleep duration was only 6.4 h. Although most participants drove <100 miles per week, 22.2 % reported at least one near miss accident and 5.6 % reported a crash. Sleep problems were more common in those with near miss accidents and actual crashes than in those without. Of note, poor sleep quality was associated with a sixfold increase in near miss accidents even after accounting for other factors. Conclusion Poor sleep is common in new parents and we provide preliminary evidence that sleep disruption in this population is associated with near miss motor vehicle accidents. Drowsy driving results in thousands of unnecessary serious injuries and fatalities each year; raising public awareness that new parents are a high-risk group is important.     

The risk of accidents among older drivers

The number of older persons holding a driver's license is rapidly increasing, as is the number of older persons driving a car. This paper examines driver accident risk by age group, focusing on the older driver. Two different measures of accident risk are used; involvement in personal injury traffic accidents per million kilometers driven, and involvement in traffic accidents where one or more pedestrians were injured per million kilometers driven. The latter measure is used to refute the assumption that the elderly's risk of being involved in personal injury accidents might, to some extent, be explained by the fact that older drivers generally tend to run a higher risk than younger drivers of being injured in the event of a traffic accident. Another motive is that it provides a measure of the extent to which drivers of different ages present a risk to their fellow road users. This study shows that drivers in the 75-84 age group are at four to six times greater risk than are middle-aged drivers of being involved in personal injury traffic accidents.     

Cellular phones and traffic accidents

Cellular phone use in motor vehicles is becoming an increasing world-wide phenomenon. Using data obtained from traffic accidents reported between 1992 and 1995 in the state of Oklahoma, USA, this study examined statistical rate-ratios of accident characteristics between drivers with or without cellular phones. Rates were calculated between cellular phone involvement and reported accident causes, types of collision, driver actions immediately prior to the accident, location of the accident, the extent of fatalities, and age and gender of drivers. Results indicated a significant increased rate among drivers with cellular phones for inattention, unsafe speed, driving on wrong side of road, striking a fixed object, overturning their vehicle, swerving prior to the accident, and running off the roadway. People with phones stood an increased risk of being killed in an accident over persons without phones. Males with phones had a significantly higher rate than females for many of accident characteristics mentioned above. Rate-ratios of some accident characteristics and fatalities increased as age increased, with the exception of drivers under age 20 yrs, who had the highest fatality rate. Limitations of the study and possible prevention alternatives are discussed.     

Sleepiness of occupational drivers

Drowsiness and sleeping at the wheel are now identified as the reasons behind fatal crashes and highway accidents caused by occupational drivers. For many years, fatigue has been associated to risk of accidents but the causes of this symptom were unclear. Extensive or nocturnal driving was associated to accidents but few reports differentiated fatigue from sleepiness. In the early nineties, epidemiological data started investigating sleepiness and sleep deprivation as cause of accidents. Sleepiness at the wheel, sleep restriction and nocturnal driving have been incriminated in 20% of traffic accidents. Drugs affecting the central nervous system (i.e., narcotic analgesics, antihistamine drugs), nocturnal breathing disorders and narcolepsy have been also associated with an increasing risk of accidents. Treatments improving daytime vigilance (i.e., nasal Continuous Positive Airway Pressure) reduce significantly the risk of traffic accidents for a reasonable economical cost. Sleep disorders among occupational drivers need to be systematically investigated. Chronic daytime sleepiness is still under diagnosed and sleep disorders (i.e. obstructive sleep apnea syndrome) are not enough explored and treated in this exposed population of sedentary males. Drivers education and work schedules integrating notions of sleep hygiene as well as promotion of sleep medicine could significantly improve road safety.     

交通事故与驾驶员因素的关系

目的　探讨驾驶员的生活事件、驾驶紧张、寻衅性驾驶等因素对交通事故的影响。方法　采用生活事件量表、驾驶紧张问卷、寻衅性驾驶行为问卷等测试了 90 5名汽车驾驶员 ,并调查了交通事故经历和影响事故的因素。结果　事故驾驶员的生活事件、驾驶紧张和寻衅驾驶得分分别为 2 1.79± 14 .10、2 3.81± 11.86、9.4 2± 8.2 5 ,明显高于无事故组 (分别为 16 .82± 8.4 5、2 0 .0 9± 10 .6 3、5 .6 6± 7.5 4 ) ,差异有显著性 (P <0 .0 1) ;且交通事故次数与生活事件、驾驶紧张、寻衅性驾驶、疲劳驾驶、每周驾车时间、饮酒指数有明显的相关 (P <0 .0 5 )。Logistic回归 (Forward :LR法 )分析表明 ,交通事故与每周驾驶时间、疲劳驾驶、寻衅性驾驶、饮酒指数的关系密切。结论　驾驶员的生活事件、驾驶紧张、寻衅性驾驶是影响交通事故的重要因素。     

Relationship between alcohol, drug use and traffic accidents related to nightlife among a Spanish youth sample in three autonomous communities in 2007

BACKGROUND: The phenomenon known as binge drinking and other drug abuse frequently occurs among young people in nightlife-related areas. This study analyzes the risk behaviours and the accident rate related to alcohol and other drugs among a sample of young people involved in nightlife. METHOD: A total of 440 young people from 3 Spanish Autonomous Communities took part. The sample size was estimated by means of Respondent Driven Sampling. The statistical analyses mined frequencies and measurements of the relationship of driving risk-related behaviour in relation to the accident rate, number of cases of drunkenness, frequency of accidents during the past month, influence of gender and age, as well as the predictiveness of these variables as regards the accident rate. RESULTS: A total of 50.2% of these young people had gotten into a vehicle with a driver who was drunk and/or under the influence of drugs, 23.2% has driven when drunk and 23.5% under the influence of drugs. The greater the degree of involvement in nightlife, the higher the frequency of drunkenness [ chi(2) (9)=112.24; p< .000 ] the greater the number of cases of drunkenness, the higher the frequency of these behaviors: getting into a vehicle with drivers who are drunk or under the influence of drugs [ c(2)=36,442, (3) p<0.001 ], drunken driving [ chi(2) =23,748, (3) p<0.001 ] and driving while under the influence of drugs [ chi(2)=23,816 (3) p<0.001 ]. The regression analysis highlighted drunken driving (odds-ratio=5.4) as the risk behaviour most related to traffic accidents. conclusions: There is a high incidence of risk behaviours while driving vehicles. Drunkenness, drug use and involvement in nightlife increase the frequency of these behaviours. Drunken driving was the best accident predictor.     

桂林市机动车驾驶员道路交通伤害影响因素分析

目的探讨机动车驾驶员道路交通伤害(RTI)的影响因素,为预防和减少RTI的发生提供科学依据。方法通过广西省公安厅交警总队收集2000—2009年桂林市区的RTI数据,对机动车驾驶员RTI影响因素进行Logistic回归分析。结果 2000—2009年桂林市发生RTI共3603起,造成506人死亡,2 911人受伤,男女死亡比例为2.54∶1;RTI的伤亡主要发生在21～45岁青年;由机动车驾驶员造成的RTI共3 208起,占总数的89.04%;疲劳驾车(P=0.000,OR=4.280,95% CI=2.055～8.916)、超速行驶(P=0.000,OR=0.269,95% CI=0.125～0.578)、纵向间距不够(P=0.001,OR=1.606,95% CI=1.815～3.164)及违反交通信号(P=0.000,OR=2.118,95% CI=1.524～2.945)等4个因素进入多因素非条件Logistic回归分析模型。结论疲劳驾车、超速行驶、纵向间距不够及违反交通信号与RTI的发生密切相关。     

A comparison of driver- and passenger-based estimates of alcohol-impaired driving

INTRODUCTION: Persons who drive after drinking or ride with drinking drivers are at increased risk of motor vehicle crash. Although alcohol is involved in 40% of fatal motor vehicle crashes yearly, there exist few systems to monitor alcohol-impaired driving. In this study we compare driver- and passenger-based estimates of the prevalence of alcohol-impaired driving. DESIGN: A random-digit-dialing telephone survey of the United States. Participants were adults aged 18 or older who were English- or Spanish-speaking from 5238 households (response rate = 56.1%). RESULTS: From the 4603 respondents who reported driving in the preceding 30 days, we estimate that there were 126 million drinking-driving episodes in the United States in 1994. From the 4380 passengers in the preceding 30 days, we estimate 191 million episodes. Three percent of respondents self-reported as drinking drivers (4.8% of males and 1.3% of females) and 4.9% as passengers of drinking drivers. Drinking drivers were more likely to be passengers of drinking drivers (44% versus 4% of nondrinking drivers). Drinking drivers were also more than twice as likely to report drinking daily, and only one half as likely to report always wearing their safety belts. CONCLUSION: Passengers who report riding with a drinking driver may provide an important estimate of the prevalence of drinking driving. Passengers of drinking drivers represent a high-risk group that is not considered in most prevention efforts. Because being a passenger of a drinking driver is not illegal, it may be an easier topic for clinicians to broach than drinking and driving.     

Tiredness and sleepiness in bus drivers and road accidents in Peru: a quantitative study]

OBJECTIVE: To evaluate the relationship that tiredness and sleepiness in bus drivers have to road accidents in Peru. Information from various countries indicates that driver sleepiness plays an important role in road accidents. However, there is only limited information on this subject in Peru. METHODS: Using a supervised, pretested survey, a cross-sectional observational and comparative study was carried out with 238 bus drivers who drive on the Northern Pan American Highway of Peru. To determine the relationship between variables the chi-square test was used, along with the Pearson correlation coefficient. The level of significance was set at P < 0.05. The variables analyzed were: tiredness, sleepiness, hours of driving per day, daily hours of sleep, body mass index, snoring, sleep apnea, and either having had or almost having had an accident while driving. RESULTS: Of the 238 drivers, all of them were men, 45% said they had had or nearly had had an accident while driving, 55% slept less than 6 hours per day, 31% had slept less than 6 hours in the 24 hours before answering the survey, and 80% were in the habit of driving more than 5 hours without stopping. Of the drivers, 56% of them reported being tired at least some of the time while driving; of this group, 65% of them reported being tired during the early morning. Seventy-six drivers (32%) said that while they were driving their eyes had fallen shut. In terms of where they slept, 194 of the drivers (81%) said they always slept in the lower luggage compartment of the bus while another driver was driving the bus or when the bus was parked in the bus terminal. The steps that drivers took to avoid falling asleep while driving included: wetting the face with water, eating fruit, opening the window of the driver's compartment, drinking coffee, listening to music, smoking, chewing coca leaves, and drinking alcohol mixed with coca leaves. In the opinion of 55% of the drivers, the leading cause of road accidents is tiredness. Accidents and near-accidents while driving occurred mainly between midnight and 6 a. m. Having an accident or a near-accident was strongly associated with tiredness and with having the eyes drop shut while driving (P < 0.0005). CONCLUSIONS: Tiredness and sleepiness while driving were common among the bus drivers, with various possible causes: acute and chronic sleep deprivation, irregular schedule changes, and sleep disorders due to the drivers' working conditions. Our results support the hypothesis that fatigue and sleepiness among bus drivers are related to road accidents.     

Vehicle accidents related to sleep: a review

Falling asleep while driving accounts for a considerable proportion of vehicle accidents under monotonous driving conditions. Many of these accidents are related to work--for example, drivers of lorries, goods vehicles, and company cars. Time of day (circadian) effects are profound, with sleepiness being particularly evident during night shift work, and driving home afterwards. Circadian factors are as important in determining driver sleepiness as is the duration of the drive, but only duration of the drive is built into legislation protecting professional drivers. Older drivers are also vulnerable to sleepiness in the mid-afternoon. Possible pathological causes of driver sleepiness are discussed, but there is little evidence that this factor contributes greatly to the accident statistics. Sleep does not occur spontaneously without warning. Drivers falling asleep are unlikely to recollect having done so, but will be aware of the precursory state of increasing sleepiness; probably reaching a state of fighting off sleep before an accident. Self awareness of sleepiness is a better method for alerting the driver than automatic sleepiness detectors in the vehicle. None of these have been proved to be reliable and most have shortcomings. Putative counter measures to sleepiness, adopted during continued driving (cold air, use of car radio) are only effective for a short time. The only safe counter measure to driver sleepiness, particularly when the driver reaches the stage of fighting sleep, is to stop driving, and--for example, take a 30 minute break encompassing a short (< 15 minute) nap or coffee (about 150 mg caffeine), which are very effective particularly if taken together. Exercise is of little use. CONCLUSIONS: More education of employers and employees is needed about planning journeys, the dangers of driving while sleepy, and driving at vulnerable times of the day.     

Pain and pain treatment were associated with traffic accident involvement in a cohort of middle-aged workers

BACKGROUND AND OBJECTIVE: To assess the influence of medical conditions on road traffic accidents among a cohort of middle-aged workers and pensioners. STUDY DESIGN AND SETTING: A longitudinal study of 13,548 participants from a cohort study of French workers. Follow-up data covered the 1989-2000 period. Adjusted hazards ratios (HR(adj)) for serious accidents were computed by Cox's proportional hazards regression with time-dependent covariates adjusted for age, occupation, annual mileage in 2001, alcohol consumption, and number of reported health problems. RESULTS: Men who reported treated dental or gingival problems (HR(adj)=8.57, 95% confidence interval CI=2.70-27.2) and women who reported treated renal colic or kidney stones (HR(adj)=9.71, 95% CI=2.40-39.3) were much more likely to have a serious traffic accident. Treated glaucoma, hiatal hernia or gastric ulcers, and diabetes among women and treated cataract among men were also found to be associated with the risk of serious traffic accidents. CONCLUSIONS: This study raises the hypothesis that pain and pain treatment (singly or in combination) could increase the risk of road traffic accident and confirms that medical conditions traditionally found to be associated with traffic accident involvement of older drivers are also risk factors for middle-aged drivers.     

Alcohol, psychoactive substances and non-fatal road traffic accidents - a case-control study

ABSTRACT: BACKGROUND: The prevalence of alcohol and other psychoactive substances is high in biological specimens from injured drivers, while the prevalence of these psychoactive substances in samples from drivers in normal traffic is low. The aim of this study was to compare the prevalence of alcohol and psychoactive substances in drivers admitted to hospital for treatment of injuries after road traffic accidents with that in drivers in normal traffic, and calculate risk estimates for the substances, and combinations of substances found in both groups. METHODS: Injured drivers were recruited in the hospital emergency department and drivers in normal conditions were taken from the hospital catchment area in roadside tests of moving traffic. Substances found in blood samples from injured drivers and oral fluid samples from drivers in moving traffic were compared using equivalent cut off concentrations, and risk estimates were calculated using logistic regression analyses. RESULTS: In 21.9% of the injured drivers, substances were found: most commonly alcohol (11.5%) and stimulants eg. cocaine or amphetamines (9.4%). This compares to 3.2% of drivers in normal traffic where the most commonly found substances were z-hypnotics (0.9%) and benzodiazepines (0.8%). The greatest increase in risk of being injured was for alcohol combined with any other substance (OR: 231.9, 95% CI: 33.3- 1615.4, p < 0.001), for more than three psychoactive substances (OR: 38.9, 95% CI: 8.2- 185.0, p < 0.001) and for alcohol alone (OR: 36.1, 95% CI: 13.2- 98.6, p < 0.001). Single use of non-alcohol substances was not associated with increased accident risk. CONCLUSION: The prevalence of psychoactive substances was higher among injured drivers than drivers in normal moving traffic. The risk of accident is greatly increased among drivers who tested positive for alcohol, in particular, those who had also ingested one or more psychoactive substances. Various preventive measures should be considered to curb the prevalence of driving under the influence of psychoactive substances as these drivers constitute a significant risk for other road users as well as themselves.