Cannabis and Driving.

As more states in the U.S legalize recreational and medicinal cannabis, rates of driving under the influence of this drug are increasing significantly. Aspects of this emerging public health issue potentially pit science against public policy. The authors believe that the legal cart is currently significantly ahead of the scientific horse. Issues such as detection procedures for cannabis-impaired drivers, and use of blood THC levels to gauge impairment, should rely heavily on current scientific knowledge. However, there are many, often unacknowledged research gaps in these and related areas, that need to be addressed in order provide a more coherent basis for public policies. This review focuses especially on those areas. In this article we review in a focused manner, current information linking cannabis to motor vehicle accidents and examine patterns of cannabis-impairment of driving related behaviors, their time courses, relationship to cannabis dose and THC blood levels, and compare cannabis and alcohol-impaired driving patterns directly. This review also delves into questions of alcohol-cannabis combinations and addresses the basis for of per-se limits in cannabis driving convictions. Finally, we distinguish between areas where research has provided clear answers to the above questions, areas that remain unclear, and make recommendations to fill gaps in current knowledge.

Surgical site, gender, and place of residence influence the time to resume driving after total joint arthroplasty.

BACKGROUND: For a large proportion of the population, especially those residing in the countryside, the use of a car for daily activities is indispensable. Following a TKA or THA procedure, the overseeing physician will usually recommend refraining from driving, sometimes up to 12 weeks after surgery with a major social and economical impact on patient's life. OBJECTIVE: Considering the legal stipulations in Germany regarding fitness to drive a motor vehicle, the aim of this study is to determine the time point when patients after total knee arthroplasty (TKA) or total hip arthroplasty (THA) take up driving again postoperatively. Further, we assessed the replaced joint, side, gender, place of residence and physician's recommendations influencing the patient in making the decision to start driving again. METHODS: 92 eligible participants, contained within the frame of a prospective experimental observational study, were contacted via telephone 12 weeks after surgery and interviewed using a structured questionnaire. The answers were statistically analysed using SPSS® Version 26 for Windows. RESULTS: Male participants resumed driving between the 6th and 7th week post-surgery, female participants resumed driving between the 8th and 9th week post-surgery. For 58.6% of patients the reason for the first post-operative use of a vehicle was medical: the journey to physical therapy or to a doctor's appointment. There were statistically significant differences regarding operated side, gender and place of residence. TKA impaired patients the most. Patients recovering from a TKA drove considerably later. Patients recovering from a right sided TKA had an increased risk (9 times) not to become an "early driver". Female patients who underwent TKA had an increased risk by a factor of 21 of becoming a "late driver". In the ageing population, surgeons, physical therapists and rehabilitation professionals need to consider new approaches in providing options for patients' mobility. Interestingly, there is a different need for early use of own vehicle in rural regions whereas in cities patients start driving later. There are clear differences between gender and surgical site. CONCLUSIONS: The rehabilitation following a right sided TKA proved a challenge with regard to the reuptake of driving. This should be taken into account when planning the course of therapy for patients who are driving regulary. Female patients could benefit from special training. TRIAL REGISTRATION: retrospectively registered, DRKS00018693 https://www.drks.de/drks_web/navigate.do?navigationId=trial . HTML&TRIAL_ID=DRKS00018693.

ADHD, depression, and motor vehicle crashes: A prospective cohort study of continuously-monitored, real-world driving.

ADHD is associated with automobile crashes, traffic fatalities, and serious road trauma, but it is unclear whether this risk is (a) driven by ADHD symptoms specifically, and (b) unique to ADHD or transdiagnostic across psychiatric disabilities, such as depression, that also have concentration problems as core symptoms. The current study provides the first prospective, continuously-monitored evaluation of crash risk related to ADHD symptoms, including the first on-road comparison of ADHD with another high-prevalence psychiatric disability (depression). A probability-based sample of 3226 drivers from six U.S. sites, including subsamples with self-reported ADHD (n = 274) and depression (n = 251), consented to have their vehicles outfitted with sophisticated data acquisition technologies to continuously monitor real-world, day-to-day driving from 'engine-on to engine-off' for 1-2 years (Mean = 440 consecutive days/driver, Mean = 9528 miles/driver). Crashes and near-crashes were objectively identified via software-based algorithms and double-coded manual validation (blinded to clinical status). Miles driven, days monitored, age, gender, education, and marital status were controlled. ADHD symptoms portended 5% increased crash risk per increase in symptom severity score (IRR = 1.05). This risk corresponded to approximately 1 biennial crash and 1 annual near-crash per driver with ADHD; crash risk doubled for drivers reporting ADHD symptom severity near the sample's maximum. Analyses based on self-reported clinical status indicated similarly elevated rates for ADHD (IRR = 1.46) and depression (IRR = 1.34) that may be related, in part, to both groups' inattention/concentration symptoms. Risk was not attenuated by ADHD usual treatment, but varied according to antidepressant medication status. Previous studies have significantly underestimated the risk for traffic crashes conveyed by ADHD and depression.

Prevalência e fatores associados à hipertensão em trabalhadores do transporte coletivo urbano no Brasil / Prevalence and factors associated with hypertension in urban public transport workers in Brazil

Contexto: Os trabalhadores do transporte coletivo urbano têm grande importância social nas cidades. Estão expostos a condições de trabalho que causam adoecimento, ganhando destaque as doenças cardiovasculares. Objetivo: Caracterizar a produção científica sobre prevalência e fatores associados à hipertensão em trabalhadores do transporte coletivo urbano no Brasil. Métodos: Revisão integrativa realizada em abril e maio de 2016, nas bases de dados Scientific Eletronic Library Online e Literatura Latino-Americana e do Caribe em Ciências da Saúde, cujo acesso se deu por meio da Biblioteca Virtual em Saúde, com a utilização dos descritores: hipertensão; pressão arterial alta; doenças cardiovasculares; saúde do trabalhador; epidemiologia; fatores de risco; e da palavra-chave "motoristas de ônibus". Foram selecionados artigos publicados entre 2002 e 2016, em português, totalizando 13 trabalhos. Resultados: A maioria dos estudos era do tipo transversal, publicada em 2006, conduzida na Região Sudeste do Brasil. As prevalências da hiper-tensão variaram entre 5,7 e 49,2%. Os fatores associados encontrados foram: obesidade; problemas psiquiátricos menores; baixo consumo de sal; consumo de gordura animal; idade acima de 46 anos; e vibração no ônibus. Conclusão: A produção científica acerca do tema é restrita, reforçando a necessidade de aprofundamento no assunto. As prevalências encontradas, por vezes, foram alarmantes. Destacaram-se fatores associados relativos ao estilo de vida e trabalho, características do indivíduo e aqueles ligados diretamente ao posto de trabalho. Considerar a hipertensão como um fator ligado ao trabalho nessa classe ocupacional é importante, evidenciando a necessidade de instituir um programa permanente de melhoria da organização do trabalho para promover saúde.

Background: Urban public transport workers have major social relevance in cities. These workers are exposed to work conditions that cause illness, cardiovascular diseases in particular. Aim: To characterize the scientific literature on the prevalence of and factors associated with hypertension in urban public transport workers in Brazil. Methods: Integrative review conducted in April and May 2016 in databases Scientific Electronic Library Online and Latin American and Caribbean Health Sciences Literature, accessed via Virtual Health Library, using the following keywords: hypertension; high blood pressure; cardiovascular diseases; occupational health; epidemiology; risk factors; and "bus drivers" in Portuguese. Studies published in Portuguese from 2002 to 2016 were selected, resulting 13 articles. Results: Most of the studies had cross-sectional design, had been published in 2006 and conducted in the Southeastern region of Brazil. The prevalence of hypertension ranged from 5.7 to 49.2%. The associated factors found included: obesity; minor psychiatric disorders; low salt consumption; consumption of animal fat; age over 46 years old; and bus vibration. Conclusion: The scientific literature on the analyzed subject is scant, which reinforces the need for more thorough studies. The prevalence rates found were sometimes alarming. Lifestyle and individual work characteristics, as well as factors directly related to work stood out. Considering hypertension as a work-related factor is relevant for this class of workers, emphasizing the need to develop a permanent program for work organization improvement to promote their health.

Acute Aortic Dissection Occurring "Behind The Wheel", Report of 11 Cases.

We investigated the clinical picture of non-traumatic acute aortic dissection (AAD) occurring behind the wheel. Between 1990 and 2014, AAD had occurred in 11 patients while driving (nine men, mean age; 58.3 years, seven commercial drivers). The symptoms included chest and/or back pain (n = 9) and syncope (n = 2). One patient with syncope caused a traffic accident. Ten patients had type A dissection (DeBakey type I) and 1 type B dissection. In-hospital mortality was 9.9% (1/11). Our data showed if affected drivers are transported to a hospital in a timely fashion, a good surgical outcome can be expected.