The role of vision-related problems in fatal road accidents in Finland.

PURPOSE: To evaluate the significance of vision-related problems in fatal motor vehicle accidents (FMVAs) based on a systematic investigation process by multidisciplinary road accident investigation teams (RAITs). METHODS: Retrospective registry-based study of all FMVAs during the years 2012-2016 in Finland in which driver causing the accident had a valid Finnish driving licence and the operated motor vehicle required having a driving licence. RESULTS: There were a total of 968 FMVAs. In only 1.3% of all the accidents, a vision-related problem was considered to have contributed to the FMVA, while an observational failure of 23.6% was the leading cause of all the FMVAs. CONCLUSIONS: Eye-originating vision problems are rarely a causative risk for FMVAs in Finland. Making current visual standards more stringent would unlikely to be effective in FMVA prevention.

Assessment of driving fitness among patients with alcohol-related visits to two hospitals in eastern Finland.

OBJECTIVE: The aim of the present study was twofold. The first aim was to explore how frequently physicians evaluate driving fitness when a patient has a serious alcohol problem, which is accomplished by examining differences in physicians' compliance with their intervention/notification obligation among different alcohol-related ICD-10 diagnoses. The second aim was to explore how many heavy alcohol users have a valid driving license. METHODS: Data from all patients with an alcohol-related ICD-10 diagnosis code as a cause of a hospital visit were collected during a three-month period from Kuopio University Hospital and North Karelia Central Hospital. RESULTS: Eighty-one percent (81%) of patients with alcohol-related ICD-10 diagnoses were heavy alcohol users and had alcohol withdrawal syndrome, alcohol-related organ disease or multidrug abuse combined with alcohol abuse. The driving fitness of these patients was significantly reduced, and the health requirements of the driving license were not met. Physicians evaluated driving fitness for only 20% of alcohol-related hospital visits/hospitalisations. Moreover, fitness to drive was evaluated in only 24% of cases of a patient with a major alcohol problem and a valid driving license. Driving fitness was most frequently evaluated in cases with alcohol-related convulsions (74%). In total, 80% of patients with a major alcohol problem had a valid driving license even though the requirements of driving fitness were not met. CONCLUSIONS: The obligation to evaluate the driving fitness of heavy alcohol users is often neglected, except in cases of alcohol-abuse-related convulsions. Physicians should play a greater role in monitoring road safety, or sanctions should be set for failures to obey the obligations. The driving fitness of a patient hospitalised due to alcohol use should be assessed more regularly. Cognition problems related to alcohol-related liver disease/alcohol-related dementia are probably often overlooked. Alcohol-abuse-related conditions are poorly recognised and remain unreported to the authorities.

Sleep versus non-sleep-related fatal road accidents.

OBJECTIVE: To study different factors that are associated with fatal sleepiness-related motor vehicle accidents (FSMVA) and in other types of fatal motor vehicle accidents (FMVA) in Finland. METHODS: All FMVA that were caused by falling asleep at the wheel (FSMVA) during the years 2005-2014 were investigated using OTI (Finnish Crash Data Institute) data. The control group consisted of 136 drivers who died in other types of FMVA in 2013. A total of 258 accidents were investigated. RESULTS: The mean age of the 122 drivers in the FSMVA group was 44 (standard deviation 19) years; there were 100 men (82%) and 22 women. The mean age of the 136 control drivers was 45 (standard deviation 19) years; there were 116 men (85%) and 20 women. Short sleep time (<6 h) during the previous night before the accident was the most prominent independent risk factor for FSMVA compared to other FMVA (p < 0.05). None of the other driver-related factors (diseases, blood alcohol level, illegal drugs, body mass index, medications, age, sex) differed significantly between the two groups. CONCLUSION: Short sleep is a major cause of fatal sleepiness-related motor vehicle accidents. Driver health factors such as sleep apnea or acute/chronic diseases as well as use of sedative medications and drugs are known risk factors for FSMVA, but these factors are associated also with other types of accidents. Healthy individuals are at risk for falling asleep while driving if they are sleep deprived. All drivers should be aware of the importance of adequate sleep.

Alcohol policy and fatal alcohol-related crashes in Finland 2000-2016.

OBJECTIVE: The purpose of this study was to explore the relationship between annual alcohol consumption per capita/alcohol price index and the number of alcohol-related fatal motor vehicle accidents (AFMVAs). We were particularly interested in whether a tax reduction in 2004 increased the number of alcohol-related accidents. METHOD: The data consisted of all fatal motor vehicle accidents (FMVAs) during the years 2000-2016 obtained from a database maintained by the Finnish Crash Data Institute (OTI). The data included all fatally injured drivers. We compared the OTI data to official statistics on annual alcohol consumption and the alcohol price index. RESULTS: There were 3,447 fatally injured drivers, of which 25% (n = 869) were intoxicated (blood alcohol concentration [BAC] ≥ 0.05%). After the reduction of the alcohol tax in 2004, the alcohol consumption rose 12.4% from 2003 to 2005 and AFMVAs rose 38%. There was a strong correlation (r = 0.7000, P < .018) between the recorded consumption of alcohol and the number of AFMVAs. There was a strong negative correlation between AFMVAs and the combined (retail + restaurant sales) alcohol price index (r = -0.7863, P = .0005). A linear mixed-effects model showed that a 1-L increase in total alcohol consumption per capita per year increases AFMVAs by 10.6 and a one-unit increase in the price index decreases AFMVAs by 1.8 per year. CONCLUSIONS: The correlation between alcohol consumption and alcohol-related crashes should be considered when making political decisions regarding alcohol price and availability. Any further liberalization of the alcohol policy would likely lead to an increase in alcohol-related fatal motor vehicle accidents. Similar consequences are likely to occur with drugs. Alcohol price policy is an effective way to improve road safety, but other measures taken to prevent FMVAs also seem to reduce the prevalence of AFMVAs.