Prescribed anti-glaucoma medication consumption and road traffic crash.

BACKGROUND: Glaucoma is one of the leading causes of visual impairment worldwide. Influence of visual defects associated with this condition, as well as potential side effects of anti-glaucoma medications on driving may be a relevant traffic safety concern. This study therefore aimed to investigate whether and/or to what extent prescribed anti-glaucoma medicine consumption is associated with increased likelihood of crash risk, and traffic crash responsibility among drivers involved in road traffic crashes. METHODS: Data from three French national databases were extracted and matched as part of the CESIR (a combination of studies on health and road safety) project. The sample included 201 497 drivers involved in an injurious road crash in France from July 1, 2005 to December 31, 2015, and an age- and sex-matched control group (113 357 drivers) that was randomly drawn from the general population. Exposure to anti-glaucoma medications were compared between responsible and non-responsible drivers involved in a crash and between drivers involved in a crash and people from the control group. RESULTS: The proportion of drivers with prescribed anti-glaucoma medicine markedly increased with age. One type (OR = 0.79, 95% CI: 0.72-0.86) and two or more types (OR = 0.82, 95% CI: 0.68-0.98) anti-glaucoma medicine prescriptions were less frequent in crash-involved drivers than in controls. One type (OR = 0.99, 95% CI: 0.88-1.12) and two or more types (OR = 1.04, 95% CI: 0.82-1.33) anti-glaucoma medicine prescriptions were not associated with crash responsibility. CONCLUSION: Our findings are reassuring as regard to existing guidelines for safe driving for individuals using anti-glaucoma medications. Our results also suggest that driving behavior adaptation is effective mitigating potential traffic crash risks for people diagnosed with glaucoma.

Deep Learning Transformer Models for Building a Comprehensive and Real-time Trauma Observatory: Development and Validation Study.

BACKGROUND: Public health surveillance relies on the collection of data, often in near-real time. Recent advances in natural language processing make it possible to envisage an automated system for extracting information from electronic health records. OBJECTIVE: To study the feasibility of setting up a national trauma observatory in France, we compared the performance of several automatic language processing methods in a multiclass classification task of unstructured clinical notes. METHODS: A total of 69,110 free-text clinical notes related to visits to the emergency departments of the University Hospital of Bordeaux, France, between 2012 and 2019 were manually annotated. Among these clinical notes, 32.5% (22,481/69,110) were traumas. We trained 4 transformer models (deep learning models that encompass attention mechanism) and compared them with the term frequency-inverse document frequency associated with the support vector machine method. RESULTS: The transformer models consistently performed better than the term frequency-inverse document frequency and a support vector machine. Among the transformers, the GPTanam model pretrained with a French corpus with an additional autosupervised learning step on 306,368 unlabeled clinical notes showed the best performance with a micro F1-score of 0.969. CONCLUSIONS: The transformers proved efficient at the multiclass classification of narrative and medical data. Further steps for improvement should focus on the expansion of abbreviations and multioutput multiclass classification.

Mental and physical health among the French population before and during the first and second COVID-19 lockdowns: Latent class trajectory analyses using longitudinal data.

BACKGROUND: The French government issued national COVID-19-related confinement and stay-at-home orders depending on different epidemic levels in a bid to stem the coronavirus pandemic and its resurgence. The long-term impact of lockdown measures on the general population may vary. We aimed to identify and characterize self-reported mental and physical health trajectories in the French population from pre-lockdown to the first and second COVID-19 lockdowns and to identify factors associated with health status variation patterns. METHODS: We did a secondary analysis of the MAVIE cohort in France. Volunteers of this national cohort were recruited between November 2014 and December 2019, and information was collected at recruitment (pre-lockdown), April-May 2020 (the first lockdown), and October-December 2020 (the second lockdown). Latent class mixed models were built to identify distinct anxiety (as measured by GAD-7) and depressive (as measured by PHQ-9) symptoms, and self-perceived mental and physical health trajectories. Factors associated with status variation were identified by logistic or multinomial regression. RESULTS: A total of 613 participants with data in all three data collection waves were included. Respondents spent almost half as much time on traditional media, websites and social media during the second lockdown as during the first. Mean anxiety scores were 1.96, 2.37 and 2.82 at pre-lockdown, and the first and second lockdowns, respectively. Mean depressive scores were 3.12, 3.36 and 3.95, respectively. Latent class mixed models fitted two and three distinct trajectory classes respectively for anxiety symptoms ('no pre-pandemic anxiety, slightly increase', 58.9%; 'consistently fair', 41.1%) and depressive symptoms ('consistently very low', 34.6%; 'consistently low', 56.1%; 'increasing and clinically significant at the second lockdown', 9.3%), and four classes for self-perceived mental and physical health. Females were more likely to belong to trajectories of the most vulnerable one as regard to the symptoms of anxiety and depression, and self-perceived mental and physical health. The younger participants were also more vulnerable to anxiety symptoms and those with a clinical diagnosis or a positive COVID-19 test for the participant or relatives were more likely to belong to vulnerable trajectories for depressive symptoms and self-perceived mental health. CONCLUSION: A continuing increase in the mean scores of anxiety and depression symptoms was observed throughout the two lockdown periods in France. Further analyses revealed distinct patterns with a small fraction of volunteers experiencing worsening mental and physical health symptoms. This vulnerable small part of the population requires targeted support.

Health conditions and the risk of home injury in French adults: results from a prospective study of the MAVIE cohort.

BACKGROUND: Home injury (HI) is a significant cause of mortality and morbidity in adults of all ages. Health conditions significantly impact HI among old adults, but little is known for other adults. STUDY DESIGN: Prospective cohort study. OBJECTIVE: We assessed the associations between health-related factors and HI's risk in a French study, the MAVIE (Mutualistes pour la recherche contre les Accidents de la VIE courante) cohort. METHODS: Poisson mixed models were fitted using health-related data information (diseases, treatments and disabilities) at baseline and the number of injuries prospectively recorded during the follow-up, adjusting for significant sociodemographics and exposure to a range of home activities. Attributable fractions were estimated based on risk ratio (RR) estimations measured in the fully adjusted models. RESULTS: A total of 6146 dwelling adults aged 15 or older were followed up for 5.1 years on average. Vertigo or dizziness (RR=2.36, 95% CI 1.06 to 5.01) and sciatica or back pain (RR=1.49, 95% CI 1.08 to 2.05) were independently associated with an increased risk of HI. These two groups of conditions showed the most significant associations among people aged 15-49, whereas musculoskeletal diseases other than rachialgias and arthropathies were the most significant health-related risk factor in people aged 50 and older. Sciatica or back pain represented the highest burden of HIs in overall adults (8%) and among people aged 15-49 (12%). CONCLUSION: Our results suggest that adults with musculoskeletal disorders and vertigo or dizziness symptoms have a higher risk of HI, regardless of age.

A web-based prospective cohort study of home, leisure, school and sports injuries in France: a descriptive analysis.

BACKGROUND: Home and leisure injuries (HLIs) are a major public health problem. Cohort studies among general population are needed for targeted preventive actions but remain scarce. We quantify and qualify the HLIs collected prospectively in the MAVIE (Mutualists against Home and Leisure Injuries) observatory, a web-based cohort among volunteers of the French general population. METHODS: Participants reported HLIs from November 2014 to December 2019. We calculated crude and standardized incidence rates (SIRs) on the entire cohort, for each of the selected socio-demographic variables and each of the injury circumstances (place and activity), mechanisms, and injury severity levels. We also described other HLIs characteristics and consequences. RESULTS: Out of the 29,931 household members enrolled in the cohort, 12,419 participants completed the questionnaires. Among them, 8640 participants provided follow-up data, leading to a follow-up of 6302 persons for 5.2 years and 2483 HLIs were reported. We obtained a SIR of 85.0 HLIs per 1000 persons-years. Most reported injuries did not require emergency department attendance or hospitalization (64%). SIRs were higher in children (< 15 years of age) (109.1 HLIs per 1000 persons-years; 95% CI, 78.2-140.1) and adults aged 70 years and older (123.7 HLIs per 1000 persons-years; 95% CI, 79.2-168.3). Struck or hit by fall was the most frequent injury mechanism (52%) and also among the most severe injuries (73% of Struck or hit by fall HLIs ending with hospitalization). Sport (without contact with nature), and leisure and play activities were the injury circumstances with higher SIRs, 15.2 HLIs per 1000 persons-years (95% CI, 14.6-15.8) and 11.2 HLIs per 1000 persons-years (95% CI, 10.7-11.6), respectively. Outdoor sport activity (in contact with nature) was the circumstance with the highest proportion of hospitalizations (18% of outdoor sports HLIs ending with hospitalization). CONCLUSION: The incidences, causes, and consequences of HLI differ by age group and are mainly related to the performance of certain activities. Although the participants in the MAVIE cohort were not representative of the French population. Our study identified potential sub-populations and specific types of HLIs that should be targeted by future studies concerning risk factors and prevention programs.

A longitudinal study of mental health before and during COVID-19 lockdown in the French population.

BACKGROUND: The impact of general population lockdown implemented in the face of the COVID-19 epidemic needs to be evaluated. We describe here a longitudinal study on the mental health of adults in France. METHODS: We did a secondary analysis of a web-based cohort, initially set up to study home and leisure injuries, in order to measure the consequences of the national lockdown implemented in France from 17 March 2020 to 11 May 2020, and to assess potential vulnerability and resilience factors. Eligible participants were invited to answer an online questionnaire designed to assess their living conditions and health during lockdown. Comparisons were done with answers provided 4.8 years earlier on average. RESULTS: On 15th April 2020, we sent email invitations to 9598 participants recruited between November 2014 and December 2019 and 1237 volunteers took part in the study by completing the online questionnaire. The proportion of those with anxiety symptoms markedly increased from 17.3 to 20.1%. The average self-rated level of mental health decreased from 7.77 to 7.58. Women, the elderly and the youngest appeared to be more vulnerable. A small living space (less than 30 m2) was associated with an increase in depression symptoms (PHQ-9 score), and poorer self-rated physical health at recruitment was associated with an increase in anxiety symptoms (GAD-7 score). On the contrary, the average self-rated level of physical health markedly increased from 7.44 to 7.94 between recruitment and lockdown, and the proportion of those who reported a level of 9 or 10 jumped from 25.7% at recruitment to 43.1% during lockdown. CONCLUSIONS: Mental health deteriorated during lockdown in France during the 2020 COVID-19 crisis. Overall, self-rated physical health improved but those who experienced a worse physical health were more likely to report anxiety symptoms.

Cohort profile: MAVIE a web-based prospective cohort study of home, leisure, and sports injuries in France.

MAVIE is a web-based prospective cohort study of Home, Leisure, and Sports Injuries with a longitudinal follow-up of French general population volunteers. MAVIE participants are voluntary members of French households, including overseas territories. Participation in the cohort involves answering individual and household questionnaires and relevant exposures and prospectively reporting injury events during the follow-up. Recruitment and data collection have been in progress since 2014. The number of participants as of the end of the year 2019 was 12,419 from 9,483 households. A total of 8,640 participants provided data during follow-up. Respondents to follow-up were composed of 763 children aged 0-14, 655 teenagers and young adults aged 15-29, 6,845 adults, and 377 people aged 75 or more. At the end of the year 2019, 1,698 participants had reported 2,483 injury events. Children, people aged 50 and more, people with poor self-perceived physical and mental health, people who engage in sports activities, and people with a history of injury during the year before recruitment were more likely to report new injuries. An interactive mobile/web application (MAVIE-Lab) was developed to help volunteers decide on personalized measures to prevent their risks of HLIs. The available data provides an opportunity to analyse multiple exposures at both the individual and household levels that may be associated with an increased risk of trauma. The ongoing analysis includes HLI incidence estimates, the determination of health-related risk factors, a specific study on the risk of home injury, another on sports injuries, and an analysis of the role of cognitive skills and mind wandering. Volunteers form a community that constitutes a population laboratory for preventative initiatives.

Factors associated with serious vehicular accidents: A cross-sectional study in hospital emergency rooms.

AIMS: Pictograms on medicine boxes warn of potential drug-related driving hazard; we studied their association with serious accidents. METHODS: Prospective study in emergency departments of the hospitals in Bordeaux and Périgueux (France), of drivers with serious (admitted at least 24 hours) or nonserious vehicular accidents. Minors, passengers, pedestrians or subjects incapable of answering an interview were excluded. Interviews ascertained driver and accident characteristics, use of drugs with or without pictograms, use of alcohol and abuse substances, sleepiness, distractions, and mind wandering at the time of the accident, RESULTS: Between 18 October 2016 and 26 December 2018, 1200 of the 6212 drivers admitted to the hospital emergency rooms, 741 nonserious, 459 serious, were interviewed. Serious accidents were associated with male sex (odds ratio 1.89, 95% confidence interval [1.36-2.64]), age above 60 years (3.64 [2.21-6.00]), driving on local roads (3.34 [2.34-4.76]), driving a motorcycle (3.39 [2.29-5.00]), having drunk alcohol within 6 hours (2.89 [1.85-4.51]) and using a drug with a pictogram during the 24 hours previous to the accident (1.57 [1.06-2.32]). From 207 police reports, 101 drivers were not responsible, and 106 were responsible, associated with age below 40 years, driving in overcast or rainy weather (2.62 [1.29-5.33]), on local roads (3.89 [1.90-7.95]), and use of at least 1 pictogram drug in the previous week (3.12 [1.31-7.41]). CONCLUSION: The known risks of alcohol and pictogram drugs, of riding motorcycles and using local roads were confirmed. As measured, behavioural sleepiness did not predict accidents.

Chronic medical conditions and their association with crash risk and changes in driving habits: a prospective study of the GAZEL cohort.

OBJECTIVES: To assess crash risk and driving habits associated with chronic medical conditions among drivers entering old age. DESIGN: Prospective cohort study. SETTING: French cohort GAZEL. PARTICIPANTS: 12 460 drivers in the analysis of road traffic crash, among whom 11 670 completed the follow-up period (2007-2014). We assessed driving cessation among 11 633 participants over the same period, and mileage and driving avoidance among the 4973 participants who returned a road safety questionnaire in 2015. MAIN OUTCOME MEASURES: Yearly occurrence of at least one road crash as a driver; time to driving cessation; mileage; driving avoidance: at night, with bad weather, in heavy traffic, with glare conditions, over long distances. RESULTS: Several potentially risky conditions (angina, myocardial infarction, coronary disease; stroke; nephritic colic, urinary stones; glaucoma) were associated with lower mileage and/or driving avoidance and did not increase crash risk. Neither driving avoidance nor lower mileage was found for other conditions associated with an increased crash risk: hearing difficulties (adjusted OR 1.19, 95% CI 1.06 to 1.34); joint disorders (1.17, 95% CI 1.06 to 1.30). Depression, anxiety and stress was associated with an increased crash risk (1.23, 95% CI 1.01 to 1.49) despite increased driving avoidance. Parkinson's disease was associated with driving cessation (adjusted HR 32.61, 95% CI 14.21 to 65.17). CONCLUSIONS: Depending on their condition, and probably on the associated risk perception, drivers entering old age report diverse driving habits. For example, hearing difficulties is a frequent condition, rarely considered a threat to road safety, and nonetheless associated with an increased crash risk.

Road traffic crash characteristics of drivers who take prescription medicines that carry a risk to driving.

BACKGROUND: The specific features of crashes involving an alcohol-intoxicated driver have been extensively characterized, but no such data are available for crashes involving a driver who has used a prescription medicine, which could help to plan and target prevention and control initiatives. This study aimed to describe the characteristics of crashes involving drivers under the influence of prescription medicines. METHODS: We took advantage of CESIR, a French record linkage study for which data were extracted and matched from three French national databases: police reports, the national police database of injurious crashes and the national health care insurance database (HCI database). The drivers included in the study were those involved in an injurious road crash in France from July 1, 2005 to December 31, 2015, whose national identity number, date of birth and sex allowed matching. Prescription medicines considered were those with the two highest levels of warning. RESULTS: Similar crash profiles were found when drivers used alcohol or medicines, particularly with respect to injury severity, type of vehicle, type of collision, type of road and cross-track profile. Alcohol-related crashes were over-represented during weekends and in low-density areas and medicine-related crashes were over-represented during weekdays and in cities of fewer than 300 000 inhabitants. While a much higher strength of association with responsibility was found for alcohol than for medicines, the proportion of crashes with drivers using medicines was twice as high as crashes with drivers using alcohol. CONCLUSION: The lower risk carried by medicines is therefore in part compensated by a higher prevalence of use, making medicines one of the hidden factors of road risk. Characterizing these crashes will therefore be useful to better focus road safety intervention on the prevention of driving under the influence of psychotropic medicines.

Stress and lasting symptoms following injury: Results from a 4-month cohort of trauma patients recruited at the emergency department.

INTRODUCTION: Recent research suggests that up to 20% of minor trauma patients admitted to the emergency department (ED) will suffer from non-specific chronic conditions over the subsequent several months. Thus, the present study assessed the correlates of symptoms that persisted at 4 months after an ED visit and, in particular, evaluated the associations between these symptoms and self-reported stress levels at ED admission and discharge. METHOD: This study was a prospective observational investigation conducted in the ED of Bordeaux University Hospital that included patients admitted for minor trauma. All participants were contacted by phone 4 months after presentation at the ED to assess the occurrence of post-concussion-like symptoms (PCLS). RESULTS: A total of 193 patients completed the follow-up assessment at 4 months; 5.2% of the participants suffered from post-traumatic stress disorder (PTSD) and 24.5% suffered from PCLS. A multivariate analysis revealed an association between PCLS and stress level at discharge from the ED (odds ratios [OR]: 2.85, 95% confidence interval [CI]: 1.10-7.40). CONCLUSIONS: The risk of PCLS at 4 months after an ED visit for a minor injury increased in association with the level of stress at discharge from the ED. These results may improve the quality of life for the millions of patients who experience a stressful injury event every year.

Trends in benzodiazepine anxiolytics and z-hypnotics use among French drivers involved in road traffic crashes from 2005 to 2015: a responsibility case-control study.

BACKGROUND: In France, benzodiazepine anxiolytics and z-hypnotics (zolpidem and zopiclone) account for the largest share of road traffic crash risk attributable to exposure to prescription drugs. The aim of this study was to monitor the evolution of the use of these prescription drugs and their association with crash risk over a period that began before the implementation of a color-graded pictogram system printed on prescription drug boxes. METHODS: Data from three French national databases were extracted and linked: the national health care insurance database, police reports, and the national police database of injurious crashes. Drivers involved in an injurious crash in France, from July 2005 to December 2015, and identified by their national identifier were included. The association with crash risk was estimated using a responsibility analysis comparing the use of benzodiazepines and z-hypnotics among drivers responsible or not for the crash. RESULTS: A total of 97,936 responsible and 103,522 non-responsible drivers involved in an injurious crash were included. The proportion of drivers exposed to benzodiazepine anxiolytics or z-hypnotics remained stable among responsible and non-responsible drivers. Among controls from the general population, the proportion of exposed individuals tended to increase. The association with crash risk remained almost constant over the study period. The odds-ratio for benzodiazepines ranged between 1.42 [1.24-1.62] at the beginning of the study period and 1.27 [1.09-1.47] at the end. CONCLUSION: Given the increase in exposure in the control group from the general population, the stability of exposure for responsible and non-responsible drivers can be interpreted as a relative effectiveness of the pictogram on driver exposure levels. On the other hand, while the intrinsic effect of a prescription drug cannot be modified, a decrease in risk could have been expected if drivers adapted their behavior as promoted by the pictogram. Our results therefore suggest that no significant change occurred in driving behaviors or consumption patterns.

Road safety and distraction, results from a responsibility case-control study among a sample of road users interviewed at the emergency room.

Despite the complexities of the driving task, more and more drivers engage in non-driving secondary tasks that take their hands (manual distraction), their eyes (visual distraction) and/or their mind (cognitive distraction) away from their primary task. Inattention arising from external distractions has received much less consideration beyond the impact of mobile phone use. We aimed to investigate the association between distraction behind the wheel and risk of being responsible for a road traffic crash in a responsibility case-control study. The study population included 1912 drivers injured in a road traffic crash recruited in two rounds of recruitment (from April 2010 to August 2011 and from March 2013 to January 2015) in the adult emergency department of Bordeaux University Hospital (France). Responsibility levels were estimated using a standardized method. Self-reported activities among a pre-established list of potential distractions were combined into four external distraction variables: visual distraction, manual distraction, auditory distraction, and verbal interaction. A significantly increased risk of being responsible for a road traffic crash was associated with the exposure to activities that take drivers' eyes off the road (adjusted odds ratio 2.99, 95% confidence interval 1.42-6.28) and activities that take drivers' hands off the wheel (adjusted odds ratio 2.12, 95% confidence interval 1.20-3.75). No significant associations were found for verbal interaction and listening to the radio and/or singing. This study suggests that beyond the use of mobile phone, particular attention must be paid to activities that involve visual and/or manual distraction.

Emotional reactivity: Beware its involvement in traffic accidents.

BACKGROUND: Reducing risk attributable to traffic accidents is a public health challenge. Research into risk factors in the area is now moving towards identification of the psychological factors involved, particularly emotional states. The aim of this study was to evaluate the link between emotional reactivity and responsibility in road traffic accidents. We hypothesized that the more one's emotional reactivity is disturbed, the greater the likelihood of being responsible for a traffic accident. METHODS: This case-control study was based on a sample of 955 drivers injured in a motor vehicle crash. Responsibility levels were determined with a standardized method adapted from the quantitative Robertson and Drummer crash responsibility instrument. Emotional reactivity was assessed with the MATHYS. RESULTS: Hierarchical cluster analysis discriminated four distinctive driver's emotional reactivity profiles: basic emotional reactivity (54%), mild emotional hyper-reactivity (29%), emotional hyper-reactivity (11%) and emotional hypo-reactivity (6%). Drivers who demonstrated emotional hypo-reactivity had a 2.3-fold greater risk of being responsible for a traffic accident than those with basic emotional reactivity. CONCLUSION: Drivers' responsibility in traffic accidents depends on their emotional status. The latter can change the ability of drivers, modifying their behavior and thus increasing their propensity to exhibit risk behavior and to cause traffic accidents.

The distracted mind on the wheel: Overall propensity to mind wandering is associated with road crash responsibility.

The role of distractions on attentional lapses that place road users in higher risk of crash remains poorly understood. We aimed to assess the respective impact of (i) mind wandering trait (propensity to mind wander in the everyday life as measured with a set of 4 questions on the proportion of time spent mind wandering in 4 different situations) and (ii) mind wandering state (disturbing thoughts just before the crash) on road crash risk using a comparison between responsible and non-responsible drivers. 954 drivers injured in a road crash were interviewed at the adult emergency department of the Bordeaux university hospital in France (2013-2015). Responsibility for the crash, mind wandering (trait/state), external distraction, alcohol use, psychotropic drug use, and sleep deprivation were evaluated. Based on questionnaire reports, 39% of respondents were classified with a mind wandering trait and 13% reported a disturbing thought just before the crash. While strongly correlated, mind wandering state and trait were independently associated with responsibility for a traffic crash (State: OR = 2.51, 95% CI: 1.64-3.83 and Trait: OR = 1.62, 95% CI: 1.22-2.16 respectively). Self-report of distracting thoughts therefore did not capture the entire risk associated with the propensity of the mind to wander, either because of under-reported thoughts and/or other deleterious mechanisms to be further explored.

Prescription medicine use by pedestrians and the risk of injurious road traffic crashes: A case-crossover study.

BACKGROUND: While some medicinal drugs have been found to affect driving ability, no study has investigated whether a relationship exists between these medicines and crashes involving pedestrians. The aim of this study was to explore the association between the use of medicinal drugs and the risk of being involved in a road traffic crash as a pedestrian. METHODS AND FINDINGS: Data from 3 French nationwide databases were matched. We used the case-crossover design to control for time-invariant factors by using each case as its own control. To perform multivariable analysis and limit false-positive results, we implemented a bootstrap version of Lasso. To avoid the effect of unmeasured time-varying factors, we varied the length of the washout period from 30 to 119 days before the crash. The matching procedure led to the inclusion of 16,458 pedestrians involved in an injurious road traffic crash from 1 July 2005 to 31 December 2011. We found 48 medicine classes with a positive association with the risk of crash, with median odds ratios ranging from 1.12 to 2.98. Among these, benzodiazepines and benzodiazepine-related drugs, antihistamines, and anti-inflammatory and antirheumatic drugs were among the 10 medicines most consumed by the 16,458 pedestrians. Study limitations included slight overrepresentation of pedestrians injured in more severe crashes, lack of information about self-medication and the use of over-the-counter drugs, and lack of data on amount of walking. CONCLUSIONS: Therapeutic classes already identified as impacting the ability to drive, such as benzodiazepines and antihistamines, are also associated with an increased risk of pedestrians being involved in a road traffic crash. This study on pedestrians highlights the necessity of improving awareness of the effect of these medicines on this category of road user.

Road traffic crash risk associated with prescription of hydroxyzine and other sedating H1-antihistamines: A responsibility and case-crossover study.

BACKGROUND: H1 antihistamines differ from each other by their ability to cross the blood-brain barrier. The resulting sedating effect can be sought in therapy but may be a driving hazard. The aim of this study was to estimate the impact of sedating H1-antihistamines on the risk of road traffic crash, with a particular focus on hydroxyzine which is also indicated as an anxiolytic in France. METHODS: The study consisted in extracting and matching data from three French nationwide databases: the national healthcare insurance database, police reports and the police national database of injurious crashes. All sedating H1-antihistamines, including hydroxyzine, were considered in the study. A case-control analysis, in which responsible drivers were cases and non-responsible were controls was performed. A case-crossover analysis, comparing for the same subject exposure during a period immediately before the crash with exposure during an earlier period, was also conducted. RESULTS: The extraction and matching procedures over the July 2005-December 2011 period led to the inclusion of 142,771 drivers involved in an injurious road traffic crash. The responsibility study found an increased risk of being responsible for an injurious road traffic crash in hydroxyzine users who were registered with a long-term chronic disease (mostly psychiatric disorders) on the day of the crash (OR=1.67 [1.22-2.30]). Among them, the risk was even higher in drivers with highest exposure levels (OR=2.60 [1.23-5.50]). There was no impact of sedating H1 antihistamine treatment initiation on the risk of crash. CONCLUSION: Even if it is difficult to disentangle the part of the increased risk that would be causally related to hydroxyzine and the part related to behaviours of patients with a heavy psychiatric disorder, our study raises the alarm on the crash risk linked to hydroxyzine utilization in countries in which the anxiolytic indication is widespread.

Road traffic crash risk associated with benzodiazepine and z-hypnotic use after implementation of a colour-graded pictogram: a responsibility study.

AIMS: To assess potential change in medicine exposure and association with the risk of road traffic crash across a time period that started before the implementation of a grading system warning of the effect of medicine on driving performance. METHODS: Data from three French national databases were extracted and matched: the national health care insurance database, police reports and the national police database of injurious crashes. Drivers involved in such crashes in France, from July 2005 to December 2011 and identified by their national identifier, were included. Association with the risk of crash was estimated using a case-control analysis comparing benzodiazepine and z-hypnotic use among drivers responsible or not responsible for the crash. RESULTS: Totals of 69 353 responsible and 73 410 non-responsible drivers involved in an injurious crash were included. Exposure to benzodiazepine anxiolytics was associated with an increased risk of being responsible for a road traffic crash during the pre-intervention period (OR = 1.42 [1.24-1.62]). The association disappeared in the post-intervention period, but became significant again thereafter. The risk of being responsible for a crash increased in users of z-hypnotics across the study period. CONCLUSIONS: Our results question the efficacy of the measures implemented to promote awareness about the effects of medicines on driving abilities. Prevention policies relating to the general driving population, but also to healthcare professionals, should be reviewed.

Mortality and Morbidity of Urban Road Traffic Crashes in Africa: Capture-Recapture Estimates in Bamako, Mali, 2012.

BACKGROUND: Low- and middle-income countries are currently facing the massive public health challenge of road traffic injuries. The lack of effective surveillance systems hinders proper assessment of epidemiologic status and intervention priorities. The objective of our study was to estimate the mortality and morbidity attributable to road crashes in Bamako, Mali using the capture-recapture method. METHODS: During the 1 January, 2012-31 April, 2012 period, we collected data on road traffic crashes from the road accident registers of the police forces of Bamako, Mali on the one hand, and from a register kept by health facilities in the same area. An automatic, then manual matching procedure was performed to find pairs of records related to the same crash victims. The number of victims and the number of fatalities were estimated by the capture-recapture method using the Chapman estimator. RESULTS: The health facility and the police registries included 3587 and 1432 records, respectively. The matching procedure identified 603 common records, 31 of which were fatalities. The annual incidence estimate for road victims was 1038 in 100 000 and the annual incidence estimate for road fatalities was 12 in 100 000. Victims from both sources were more likely to be male, in the 15-34 age group, and almost half of all injured road users and two in three fatalities were using motorized two-wheelers. One victim out of five was a pedestrian. CONCLUSION: Our estimates are in line with available literature data from low-income countries. While more cases were reported by health facilities than by police forces, we believe that an effective surveillance system should not be based solely on medical reports as much would be missing as regards the crash circumstances and characteristics.

The increased risk of road crashes in attention deficit hyperactivity disorder (ADHD) adult drivers: driven by distraction? Results from a responsibility case-control study.

BACKGROUND AND OBJECTIVE: Both distractions (external and internal) and attention-deficit/hyperactivity disorder (ADHD) are serious risk factors for traffic crashes and injuries. However, it is still unknown if ADHD (a chronic condition) modifies the effect of distractions (irregular hazards) on traffic crashes. The objective of this study was to assess the effects of distractions and ADHD on traffic crash responsibility. METHODS: A responsibility case-control study was conducted in the adult emergency department of Bordeaux University Hospital, France. Subjects were recruited among drivers injured in a motor vehicle crash between April 2010 and August 2011. Responsibility levels were estimated using a standardized method. Frequencies of exposures were compared between drivers responsible and drivers not responsible for the crash. Independent risk factors were identified using a multivariate logistic regression including test interactions between distractions and ADHD. RESULTS: A total of 777 subjects were included in the analysis. Factors associated with responsibility were distraction induced by an external event (adjusted OR (aOR) = 1.47; 95% confidence interval (CI) [1.06-2.05]), distraction induced by an internal thought (aOR = 2.38; CI: [1.50-3.77]) and ADHD (aOR = 2.18 CI: [1.22-3.88]). The combined effect of ADHD and external distractions was strongly associated with responsibility for the crash (aOR = 5.79 CI: [2.06-16.32]). Interaction assessment showed that the attributable proportion due to the interaction among participants with both exposures was 68%. DISCUSSION: Adults with ADHD are a population at higher risk of being responsible for a road traffic crash when exposed to external distractions. This result reinforces the need to diagnose adult ADHD and to include road safety awareness messages delivered by the physician. Developing advanced driver assistance systems devoted to the management of attention lapses is also increasingly relevant for these drivers.