Risk Of Car Accidents Research Articles

Driving with diabetes: What is the Portuguese doctors’ and patients’ knowledge?

IntroductionIn the last years there was an increasing interest about diabetes and driving. Nowadays there are strict rules for diabetic drivers in most countries. The aim of this study was to assess whether the patients and the doctors were aware of the rules and recommendations in Portugal. MethodsAn anonymous questionnaire was applied to diabetic patients who were drivers attending our center for 8 weeks. A web-based questionnaire was e-mailed to the Endocrinology, Diabetes and Metabolism Portuguese Society and Diabetes Portuguese Society associates. ResultsNinety-three patients were surveyed. Only 20 patients had discussed this subject with their doctor and 69.9% thought there was not any risk to driving by being a diabetic. Twenty-nine percent never tests blood glucose prior to driving and for the majority it is safe to drive until blood glucose is 60mg/dl. One patient reported a crash due to hypoglycemia. Eighty-eight doctors completed the questionnaire. Fourteen did not associate diabetes with an increased risk of car accidents and 59.1% discuss the driving and diabetes issue with less than 50% of their diabetic patients. Only 54% advise their patients to test blood glycaemia prior to driving and for 46.6% it is safe to drive with blood glucose lower than 90mg/dl. Sixteen did not know recurrent hypoglycemia was a contraindication to driving and eight that impaired awareness of hypoglycemia might also be a contraindication. Discussion/conclusionsThis study shows a lack of patients’ knowledge about safe driving and the rules they must follow. In our opinion, it is fundamental to improve doctor's and patients’ knowledge in this subject.

Changes in eye movements and driving performance at different intersections as a function of age and turn type

This research examined the changes in eye movements and driving performance at different intersection types, as a function of age and turn type. The results showed that when making a right turn, older adult drivers tend to spend less time in scanning the forward direction and more time in observing the right-side view than young adult drivers. Also older adult drivers tend to enter and exit the intersection slower than do young adult drivers. These results imply that older adult drivers are exposed to a much higher risk of car accidents than young adult drivers at a four-way intersection. Paradoxically, the results also imply that older adult drivers tend to be more aware of unexpected situations on three-way intersections, compared to young adult drivers. Relevance to industryThis study provides that elderly drivers are not always exposed to dangerous driving situations, but can cope more effectively in hazardous situation depending on the intersection and turn types than young adult drivers.

Troubles du sommeil et de l’éveil : mise au point

Insomnia is the most prevalent sleep disorders and affects severely 10% of adults worldwide. From poor sleep to insomnia, the severity of sleep disorders should be assessed clinically and by the use of validated questionnaires based on international consensual definitions. One main sign of insomnia is impaired daytime functioning. Insomnia may be treated with hypnotics only for a limited duration. Behavioural and cognitive therapies have been found efficient on chronic insomnia. Sleepiness is also a common sleep disorders due to altered sleep schedules, sleep deprivation, sleep disorders or as an adverse effect of some treatments. The risk of car accidents and the impaired quality of daytime functioning are the main consequences of sleepiness. The aim of this paper is to give some recommendations for the diagnosis and treatment of insomnia and sleepiness.

SIMULATION STUDY OF TRAFFIC ACCIDENTS IN BIDIRECTIONAL TRAFFIC MODELS

Conditions for the occurrence of bidirectional collisions are developed based on the Simon–Gutowitz bidirectional traffic model. Three types of dangerous situations can occur in this model. We analyze those corresponding to head-on collision; rear-end collision and lane-changing collision. Using Monte Carlo simulations, we compute the probability of the occurrence of these collisions for different values of the oncoming cars' density. It is found that the risk of collisions is important when the density of cars in one lane is small and that of the other lane is high enough. The influence of different proportions of heavy vehicles is also studied. We found that heavy vehicles cause an important reduction of traffic flow on the home lane and provoke an increase of the risk of car accidents.

A European study on alcohol and drug use among young drivers: the TEND by Night study design and methodology

BackgroundYoung individuals are the age group with the highest risk of car accidents. One of main explanations relies on the use of psychoactive substances (alcohol, illegal and medicinal drugs), which are known to be major risk factors of road accidents, and whose consumption is almost universally more common among younger drivers. Although the correlation between psychoactive substances use and decrease in driving performance has been established in controlled experimental or laboratory settings, few studies were conducted in naturalistic circumstances. The TEND by Night project has been designed to evaluate the relationship between driving performance and psychoactive substances assumption in young drivers enrolled at typical places of consumption.Methods/DesignThe TEND by Night project, endorsed by the European Commission, is a multidisciplinary, multi-centric, cross-sectional study conducted in six European countries (Italy, Belgium/Netherlands, Bulgaria, Spain, Poland and Latvia). The study population consists of 5000 young drivers aged 16-34 years, attending recreational sites during weekend nights. The intervention is based on the portal survey technique and includes several steps at the entrance and exit of selected sites, including the administration of semi-structured questionnaires, breath alcohol test, several drug assumption test, and measurement of the reaction time using a driving simulator. The main outcome is the difference in reaction time between the entrance and exit of the recreation site, and its correlation with psychoactive substances use. As a secondary outcome it will be explored the relationship between reaction time difference and the amount of consumption of each substance. All analyses will be multivariate.DiscussionThe project methodology should provide some relevant advantages over traditional survey systems. The main strengths of the study include the large and multicentric sample, the objective measurement of substance assumption (which is typically self-reported), the application of a portal survey technique and the simultaneous evaluation of several psychoactive substances.

Urban consolidation centres for medium-size touristic cities in the Westpomeranian Region of Poland

Among the many problems arising in cities, freight delivery is one of the most important ones. Increasing demands of the recipients (due to e-commerce development) leads to pressure and intensification of transporting freight through inner-city areas. This generates many unwanted results such as congestion, escalation of waste and environmental devastation, increased noise levels, greater than before, such as the risk of car accidents. An important alternative for traditional freight delivery are Urban Consolidation Centres. Utilizing UCC gives a chance to eliminate the harmful effects due to transporting freight by large-size vehicles through the city areas. This paper is focused on analysis of perspectives of urban consolidation centres development in Westpomeranian Region of Poland, concentrating on medium-size cities. For cities like Świnoujście and Kołobrzeg implementation of urban consolidation centres is important for efficiency of freight delivery especially during holiday periods.

Repos de sécurité : quels enjeux ?

In 2003 were promulgated the texts regulating rest and safety, in the USA (approved by the ACGME) and in France (January 9th, 2001 and September 14th, 2001). The institution of the “rest for safety”, an eleven hours duration interruption of activity, immediately after a night-call, can be viewed as a progress in the search for safety. Several studies showed a link between excessive work hours and occurrence of medical incidents related to tiredness. However published data do not show a link between tiredness and patients endangering. The tiredness resulting from sleep deprivation and disturbances in circadian rhythms is a cumulative phenomenon erased by a period of rest. In spite of a large individual variability, tiredness increases anxiety scores, irritability, depression and it deteriorates cognitive performances. The concept of “prophylactic” rest considers that a subject cannot start, rested, a work if he did not sleep at least 5 hours the previous night, or 12 hours during the previous 48 hours. The second important aspect of the rest for safety is the long-term prevention of potential pathologies in medical staff, in particular burnout syndrome. In our profession, night calls are considered most stressful; the psychological stress related to anticipation and night context causes measurable cardiovascular disturbances in anesthesiologists. Shift-work sleep disorders may induce gastric ulcers, heart attacks, metabolic syndrome, depression and accidents related to somnolence. Long duration work-hours, accompanied by sleep deprivation, may double the risk of car accidents in junior physicians, in whom vigilance levels can compare with those of patients concerned by narcolepsy or with the cognitive disturbances induced by alcohol intoxication. Reduced work-hours improve vigilance and divide by three the rate of serious medical errors. True opportunities of sleep and control of sleep duration at the individual level could be suggested. The idea that taking the necessary rest would be synonymous with a decrease of efficiency in patient care is not demonstrated, but the danger of a poorer information transmission should be handed with an optimization of our manpower and organization. Aging is accompanied by a progressive disorganization of sleep. The foreseeable shortage of manpower, synonymous with aging of the medical actors and increased vulnerability to tiredness, is a posteriori the justification of the institution of the rest for safety.

Professional Shift-Work Drivers who Adopt Prophylactic Naps can Reduce the Risk of Car Accidents During Night Work

Night work can be dangerous because both circadian sleep propensity (process C) and sleep pressure due to the prolonged wakefulness (process S) contribute to the reduction of vigilance levels. As naps are a countermeasure to sleepiness, this study evaluates the role they play in preventing sleep-related accidents in Italian shift-working police drivers. The study concerns highway car accidents that occurred to Italian shift-working police drivers; it was performed in 2 steps: a retrospective analysis of the overall number of accidents that occurred during the years 1993--1997 (n, 1195), followed by a validation analysis of a smaller cohort of accidents prospectively collected during 2003 (n, 84). N/A. RETROSPECTIVE ANALYSIS: The influence of process S, process C, driver characteristics, and context conditions on accident risk, estimated by means of Cox hazard regression, revealed that nighttime accident risk was mainly influenced by process S levels. Consequently, an experimental mathematical model linking the hourly observed number of accidents to process S levels was designed. Its generalization to the theoretical case of drivers omitting naps showed an increase of about 38% of accidents. PROSPECTIVE ANALYSIS: In order to validate our results, we compared retrospective and prospective sleep patterns: no statistical difference was found. Again, the hourly number of accidents increased with homeostatic sleep pressure; the theoretical efficacy of napping was quantified in 48% accidents decrease. Our data seem to confirm that napping before working a night shift is an effective countermeasure to alertness and performance deterioration associated with night work. Moreover, this self-initiated behavior could have a prophylactic efficacy in reducing the number of car accidents.

Effects of after-midnight intake of zolpidem and temazepam on driving ability in women with non-organic insomnia

Background Occasionally, insomniac patients may take a sleeping pill after midnight. This may have consequences on their ability to drive a car and result in an increased risk of car accidents. Methods This double-blind, randomized, placebo-controlled, three-treatment three-period cross-over study investigated the effects of two frequently prescribed hypnotics of different classes in a real life condition on driving performance and psychomotor skills in insomniac women. Single doses of zolpidem 10 mg (Z), temazepam 20 mg (T) or placebo (P) were administered at 2:00 a.m. to 19 women aged 35–60 years in three treatment periods separated by wash-out periods of 3–14 days. After polysomnography at baseline and each treatment night, patients underwent, 5.5 h after drug intake at 7:30 a.m. on the next morning, a STISIM™ driving simulator test, and a subsequent neuropsychological test (FePsy). Results Eighteen insomniac women were included in the analysis (mean age 50 years, mean weight 69 kg, mean BMI 25.6 kg/m 2). There were no differences between treatments for the primary outcome measure (mean time to collision; baseline: 0.120 s, P: 0.124, T: 0.118, Z: 0.124; P≥0.12 for all pairwise comparisons). No differences were recorded for speed deviation and reaction time to tasks for the verum treatments, however, lane position deviation was greater after administration of zolpidem in comparison to both placebo and temazepam ( P=0.025 and 0.05, respectively). There were no differences between treatments in the FePsy test. Both medications were well tolerated. Conclusions 5.5 h after drug administration there were no major differences in psychomotor performances between both zolpidem and temazepam compared to placebo, which indicates the absence of significant residual effects at that time. However, certain patients were more susceptible than others to the drug effects (two patients with high number of collisions). This underlines the necessity to strongly advocate against the late intake of hypnotics if patients intend to drive a car early the next morning.

Fatigue in anesthesia: implications and strategies for patient and provider safety.

HEALTHCARE delivery takes place 24 h a day, 7 days a week, and is colloquially termed a “24/7” operation. Anesthesia providers are required to deliver critical around-the-clock care to a variety of patients. This parallels the situation in many other domains that provide such services, e.g., transportation, law enforcement, communications, fire fighting, technology, manufacturing, and the military. Even “convenience” industries (e.g., gas stations and grocery stores) now provide uninterrupted access. These continuous operational demands present unique physiologic challenges to the humans who are called on to provide safe operations within these systems. Human physiologic design dictates circadian patterns of alertness and performance and includes a vital need for sleep. Human requirements for sleep and a stable circadian clock can be, and often are, in direct opposition to the societal demand for continuous operations. Recently, patient safety has taken center stage in health care. The Institute of Medicine’s report “To Err Is Human: Building a Safer Health System,” revealed that medical errors contribute to many hospital deaths and serious adverse events. The response to this report was widespread and included the Quality Interagency Coordination Task Force’s response to the President of the United States, “Doing What Counts for Patient Safety: Federal Actions to Reduce Medical Errors and Their Impact.” 2 This report listed more than 100 action items to be undertaken by federal agencies to improve quality and reduce medical errors. One action promised by the Agency for Healthcare Research and Quality was “the development and dissemination of evidence-based, best safety practices to provider organizations.” In addition to the multiple recommendations to improve patient safety, the report from the Agency for Healthcare Research and Quality included a review chapter on sleep, fatigue,# and medical errors.** There is evidence that the issue of fatigue in health care is coming to prominence on a national level. In April 2001, Public Citizen (a consumer and health advocacy group) and a consortium of interested parties petitioned the Occupational Safety and Health Administration to implement new regulations on resident work hours (table 1). The primary intent of the regulations is to provide more humane working conditions, which the petitioners declare will result in a better standard of care for all patients. Also, the Patient and Physician Safety and Protection Act of 2001, which would limit resident physician work hours, was introduced in Congress. Recently, the Accreditation Council on Graduate Medical Education, the accrediting organization for residency training programs in the United States, has approved common program requirements for resident duty and rest hours that will take effect in July 2003.†† This article is accompanied by an Editorial View. Please see: Lydic R: Fact and fantasy about sleep and anesthesiology. ANESTHESIOLOGY 2002; 97:1050–1.

Motor vehicle crashes and abnormal driving behaviours in patients with dementia in Mendoza, Argentina

Studies conducted in industrialized countries have shown that elderly demented subjects have increased risk of car accidents. However, there is no information about the effect of dementia on driving habits in non-industrialized countries. The number of motor vehicle crashes (MVC) and abnormal driving behaviours (ADB) (e.g. not recognizing traffic lights, driving in the middle of the road, etc.) were assessed with a semi-structured interview in 56 demented subjects and 31 elderly controls, all of whom were active drivers, at the Regional Registry of Dementia in Mendoza. Detailed neurological, psychiatric and neuropsychological examinations were also conducted on each subject. The presence of dementia and sex (male) predicted ADB, MVC and number of MVC (two or more). Among demented patients, ADB and MVC were associated with sex (male) and number of MVC was associated with sex (male) and Blessed Dementia Rating Scale for activities of daily living scores. Neither ADB, MCV, or number of MVC were associated with education level, or with cognitive or psychiatric measures. These findings showed that in developing countries, dementia has a significant contribution to MVC and ADB, as occurs in industrialized nations. Consequently, legislation to curb the risk of accidents caused by demented patients should be implemented. Furthermore, physicians must encourage demented patients (or their families) to discontinue driving, even those with mild dementia syndrome.

Risk of automobile accidents among elderly drivers and impairments or chronic diseases : J. Gresset, F. Meyer, Revue Canadienne de Santé Publique, 85(4), 282

Risk of automobile accidents among elderly drivers and impairments or chronic diseases : J. Gresset, F. Meyer, Revue Canadienne de Santé Publique, 85(4), 282

The Effect of Epilepsy or Diabetes Mellitus on the Risk of Automobile Accidents

Previous studies of possible associations between chronic medical conditions and traffic safety have been inconsistent and subject to bias because of the incomplete identification of affected persons. Recent advances in the diagnosis and management of epilepsy and diabetes mellitus have improved the control of these disorders and suggest a need to reexamine the risk of traffic mishaps among patients with these conditions. We conducted a population-based retrospective cohort study of 30,420 subjects 16 to 90 years of age, with and without epilepsy or diabetes mellitus. Subjects included all the licensed drivers in seven contiguous ZIP Code areas in which the Marshfield Clinic and St. Joseph's Hospital, Marshfield, Wisconsin, are the primary sources of medical care. Standardized rates of moving violations and accidents over a four-year period (1985 through 1988) were compared in affected and unaffected cohorts. Standardized mishap ratios for subjects with diabetes were 1.14 for all moving violations (P = 0.23) and 1.32 for accidents (P = 0.01); for subjects with epilepsy the ratios were 1.13 for moving violations (P = 0.26) and 1.33 for accidents (P = 0.04). We conclude that drivers with epilepsy or diabetes mellitus have slightly increased risks of traffic accidents as compared with unaffected persons. The increases in risk observed in our study were generally smaller than those in previous studies, and we believe they are not great enough to warrant further restrictions on driving privileges.

Risk of automobile accidents in cigarette smokers: Brison RJ Can J Public Health 81:102–106 Mar 1990

Risk of automobile accidents in cigarette smokers: Brison RJ Can J Public Health 81:102–106 Mar 1990

The risk of automobile accidents with seizures occurring while driving: relation to seizure type.

Automobile accidents occurred with 55% of seizures in epileptic drivers with both well-described seizures at the wheel and a well-classified epilepsy diagnosis. A further 38% of seizures would have led to accidents in less fortunate settings. Complex partial seizures occurred in 81% of patients and were responsible for 88% of accidents. Immediate alterations of consciousness were significantly more likely to lead to accidents than were seizures beginning with an aura. Motor activity during simple partial seizures was also responsible for some accidents. Differences in seizure frequency may account for different crude accident rates among studies of epileptic drivers. We suggest guidelines for licensing restrictions that seem safe and reasonable.