The association between diabetes and safe driving: A systematic search and review of the literature and cross-reference with the current guidelines.

AIMS: We conducted this review to characterize the quality of evidence about associations between diabetes and safe driving and to evaluate how these findings are reflected within current guidelines available to support clinicians and their patients with diabetes. METHODS: The first stage entailed a systematic search and review of the literature. Evidence surrounding harms associated with diabetes and driving was identified, screened, extracted and appraised for quality utilizing the Newcastle Ottawa Scales (NOS). Next, relevant guidelines regarding driving and diabetes were sourced and summarized. Finally, the identified guidelines were cross-referenced with the results of the systematic search and review. RESULTS: The systematic search yielded 12,461 unique citations; 52 met the criteria for appraisal. Fourteen studies were rated as 'high', two as 'medium' and 36 as 'low'. Studies with ratings of 'high' or 'medium' were extracted, revealing a body of inconsistent methods and findings. These results, cross-referenced with the guidelines, suggest a lack of agreement and a limited evidence base to justify recommendations. CONCLUSIONS: The results presented emphasize the need for a better understanding of the impacts of diabetes on safe driving to inform evidence-based guidelines.

Efficacy of surgical skin preparation solutions in hip arthroplasty: a prospective randomized trial.

BACKGROUND: The use of an effective antimicrobial preoperative skin preparation solution is essential in preventing infections after surgery, but the findings in the literature regarding efficacy are not necessarily applicable to surgery involving the hip. The purpose of the present study was twofold: 1) to examine the native bacteria on the skin at the hip and 2) to determine the efficacy of 2 surgical skin preparation solutions at eliminating bacteria from the hip site in patients undergoing total hip arthroplasty. METHODS: We conducted a prospective randomized controlled trial in consecutive adult patients who underwent primary total hip arthroplasty at a single institution from October 2014 to December 2015. Each patient was randomly allocated to be treated with 1 of 2 commonly used surgical skin preparation solutions: ChloraPrep (2% chlorhexidine gluconate and 70% isopropyl alcohol) or DuraPrep (0.7% iodophor and 74% isopropyl alcohol). Aerobic and anaerobic samples were obtained for culture before skin preparation, immediately after skin preparation and after skin closure. RESULTS: Full data were obtained for 105 patients: 54 in the ChloraPrep group and 51 in the DuraPrep group. Staphylococcus epidermidis, Corynebacterium and Micrococcus luteus were the organisms most commonly isolated from the hip before skin preparation. Positive bacterial culture results were obtained in 50 patients (93%) in the ChloraPrep group and 48 patients (94%) in the DuraPrep group. Immediately after skin preparation, the overall proportion of positive culture results was significantly lower in the DuraPrep group than the ChloraPrep group (14% v. 35%, adjusted relative risk 0.40, 95% confidence interval 0.18-0.85). After wound closure, there was no significant difference in the rate of positive culture results between the 2 groups. CONCLUSION: DuraPrep was more effective than ChloraPrep at eliminating skin flora at the hip initially on application, but the 2 solutions were equally effective at the time of closure. Further study with larger samples is required to identify any influence of skin preparation solution on the incidence of prosthetic joint infection.

Women's Spiritual Intelligence is Associated With Fewer Depression Symptoms: Exploratory Results From a Canadian Sample.

While some evidence suggests a relationship between spiritual intelligence and depression, overall, research has yielded inconclusive results. We set out to expand the literature by further exploring this relationship in a Canadian sample. We also aimed to investigate the moderating effect of gender, shedding additional light on an interaction mostly overlooked in the current research. A clinical sample of 39 participants (66.7% female) completed measures of SI and depression before receiving treatment for depression in an outpatient mental health clinic. Results indicated that overall, there was a negative relationship between SI and depression symptoms (r(39) = - 0.55, p < .001); our findings illustrate that this beneficial relationship was driven by women. Future research of interventions aimed at improving spirituality as a means of reducing depression symptoms is warranted.

Epidemiology of invasive pneumococcal disease in indigenous and non-indigenous adults in northwestern Ontario, Canada, 2006-2015.

BACKGROUND: Despite the use of pneumococcal vaccines, indigenous populations are consistently disproportionately affected by invasive pneumococcal disease (IPD). With recent changes in Ontario's provincial pneumococcal vaccination program, we sought to evaluate the epidemiology and burden of IPD in northwestern Ontario (NWO) Canada - a region that contains a substantial (19.2%) indigenous population. METHODS: We retrospectively reviewed all adult cases of IPD that were reported to the Thunder Bay District Health Unit, in Thunder Bay, Ontario, Canada, over a 10-year period (2006-2015). Patients admitted to the Thunder Bay Regional Health Sciences Centre with IPD had their charts reviewed to abstract clinical data. Statistical analysis, including incidence rates of IPD, was performed. RESULTS: Two hundred sixty-two cases of IPD occurred over the 10-year observation period and clinical data was available for 182 cases. Fifty-three of 182 (29.1%) patients were indigenous. 73 of 182 (40.1%) of patients were immunocompromised. Indigenous patients with IPD were more likely to be immunocompromised than non-indigenous patients (p < 0.001). Serotype data was available for 159 cases of IPD; PCV7, PCV13, and PPV23 covered 5.7%, 28.3%, and 79.2% of isolates, respectively, while 29 (20.8%) were non-vaccine serotypes. The annual incidence rate of IPD ranged from 8.9 to 25.9 per 100,000 among adults 18-64 years old; among adults 65 years of age and older the annual incidence of IPD ranged from 18.5 to 60.7 per 100,000. CONCLUSION: Among adults in NWO, Canada, there is a high incidence of IPD. Immunocompromised indigenous adults in NWO may benefit from pneumococcal vaccination coverage. Emerging non-vaccine serotypes of Streptococcus pneumoniae warrant the consideration of the provincial pneumococcal vaccination program.

Using Serial Trichotomization With Common Cognitive Tests to Screen for Fitness to Drive.

OBJECTIVE: The aim of this study was to illustrate the use of serial trichotomization with five common tests of cognition to achieve greater precision in screening for fitness to drive. METHOD: We collected data (using the Montreal Cognitive Assessment, Motor-Free Visual Perception Test, Clock-Drawing Test, Trail Making Test Part A and B [Trails B], and an on-road driving test) from 83 people referred for a driving evaluation. We identified cutpoints for 100% sensitivity and specificity for each test; the driving test was the gold standard. Using serial trichotomization, we classified drivers as either "Pass," "Fail," or "Indeterminate." RESULTS: Trails B had the best sensitivity and specificity (66.3% of participants correctly classified). After applying serial trichotomization, we correctly identified the driving test outcome for 78.3% of participants. CONCLUSION: A screening strategy using serial trichotomization of multiple test results may reduce uncertainty about fitness to drive.

Mindfulness-based cognitive therapy reduces symptoms of depression in people with a traumatic brain injury: results from a randomized controlled trial.

OBJECTIVE: We sought to determine if we could reduce symptoms of depression in individuals with a traumatic brain injury using mindfulness-based cognitive therapy. SETTING: The study was conducted in a community setting. PARTICIPANTS: We enrolled adults with symptoms of depression after a traumatic brain injury. DESIGN: We conducted a randomized controlled trial; participants were randomized to the 10-week mindfulness-based cognitive therapy intervention arm or to the wait-list control arm. MAIN MEASURES: The primary outcome measure was symptoms of depression using the Beck Depression Inventory-II. RESULTS: The parallel group analysis revealed a greater reduction in Beck Depression Inventory-II scores for the intervention group (6.63, n = 38,) than the control group (2.13, n = 38, P = .029). A medium effect size was observed (Cohen d = 0.56). The improvement in Beck Depression Inventory-II scores was maintained at the 3-month follow-up. CONCLUSION: These results are consistent with those of other researchers that use mindfulness-based cognitive therapy to reduce symptoms of depression and suggest that further work to replicate these findings and improve upon the efficacy of the intervention is warranted.

A randomized, double-blind, placebo-controlled study to evaluate the effects of alendronate on bone mineral density and bone remodelling in perimenopausal women with low bone mineral density.

BACKGROUND: Perimenopausal women can experience rapid bone loss at skeletal sites with both cortical and cancellous bone, increasing the prevalence of osteoporosis following menopause. METHODS: We conducted a 12-month randomized placebo-controlled trial evaluating the effects of alendronate 70 mg with 2800 IU cholecalciferol administered once per week for 12 months in comparison with placebo and cholecalciferol. The primary end-point was the percentage change in the lumbar spine bone mineral density (BMD) from baseline to 12 months. Secondary end-points were the change in BMD at the femoral neck and changes in biochemical markers of bone turnover. RESULTS: Forty-five women were recruited to participate in the study. Five subjects withdrew from the study before randomization for unrelated reasons. Forty subjects were randomly allocated to the alendronate and placebo groups. The mean lumbar spine MD in women treated with alendronate increased by 3.66% (mean paired difference, µd = 0.032; ± 0.008 SE) at 12 months, compared with a reduction of 3.33% (µd = -0.030; ± 0.008 SE) in the control group (P < 0.001). In the femoral neck, the mean BMD in the alendronate group increased by 2.07% (µd = 0.014; ± 0.009 SE) at 12 months, compared with a reduction of 1.87% (µd = -0.014; ± 0.008 SE) in the control group (P = 0.046). There were no differences in BMD between the alendronate and placebo groups at the total hip sites after 12 months. At 12 months, both bone-specific alkaline phosphatase and urinary N-telopeptide were significantly reduced, by 37.79% (µd = -9.90; ± 1.92 SE) and 27.21% (µd = -11.68; ± 4.80 SE) respectively, in the alendronate group; in the control group, these levels increased (P < 0.001). CONCLUSION: Weekly treatment with alendronate 70 mg and cholecalciferol 2800 IU increases BMD and decreases bone turnover in perimenopausal women.

Contexte : Les femmes périménopausées peuvent connaître une perte osseuse rapide aux points du squelette qui comptent des os tant corticaux que spongieux, ce qui accroît la prévalence de l'ostéoporose à la suite de la ménopause. Méthodes : Nous avons mené un essai comparatif randomisé avec placebo (d'une durée de 12 mois) qui cherchait à évaluer les effets de l'administration de 70 mg d'alendronate et de 2 800 UI de cholécalciférol (une fois par semaine, pendant 12 mois), par comparaison avec l'administration d'un placebo et de cholécalciférol. Le critère d'évaluation principal était la modification (en pourcentage, entre la valeur de départ et la valeur à 12 mois) de la densité minérale osseuse (DMO) de la colonne lombaire. Parmi les critères d'évaluation secondaires, on trouvait la modification de la DMO du col fémoral et les modifications des marqueurs biochimiques du renouvellement des cellules osseuses. Résultats : Nous avons sollicité la participation de 45 femmes à l'étude. Cinq participantes se sont désistées avant la randomisation pour des raisons n'ayant rien à voir avec l'étude. Quarante femmes ont été affectées au hasard à un groupe devant recevoir de l'alendronate ou à un groupe devant recevoir un placebo. Chez les femmes traitées à l'alendronate, la DMO moyenne de la colonne lombaire a connu une hausse de l'ordre de 3,66 % (différence moyenne appariée, µd = 0,032; ± 0,008 ET) à 12 mois, par comparaison avec une baisse de l'ordre de 3,33 % (µd = −0,030; ± 0,008 ET) au sein du groupe témoin (P < 0,001). Au niveau du col fémoral au sein du groupe « alendronate ¼, la DMO moyenne a connu une hausse de l'ordre de 2,07 % (µd = 0,014; ± 0,009 ET) à 12 mois, par comparaison avec une baisse de l'ordre de 1,87 % (µd = −0,014; ± 0,008 ET) au sein du groupe témoin (P = 0,046). Aucune différence en matière de DMO n'a été constatée entre les groupes « alendronate ¼ et « placebo ¼ pour ce qui est de l'ensemble des sites de la hanche après 12 mois. À 12 mois, tant la phosphatase alcaline propre aux os que le N-télopeptide urinaire ont connu une baisse significative, de l'ordre de 37,79 % (µd = −9,90; ± 1,92 ET) et de 27,21 % (µd = −11.68; ± 4,80 ET) respectivement, au sein du groupe « alendronate ¼; au sein du groupe témoin, les taux de ces marqueurs ont connu une hausse (P < 0,001). Conclusion : L'administration hebdomadaire d'un traitement faisant appel à 70 mg d'alendronate et à 2 800 UI de cholécalciférol entraîne une hausse de la DMO et une baisse du renouvellement des cellules osseuses chez les femmes périménopausées.

Omission of alcohol skin cleansing and risk of adverse events in long-term care residents undergoing COVID-19 vaccination: A cohort study.

Despite a lack of clinical data demonstrating the effectiveness of alcohol swab cleansing prior to vaccinations as a prophylactic measure to prevent skin infections, it is recommended for vaccine administration by the Canadian Immunization Guide. The objective of this study was to evaluate the risk of adverse events after omitting alcohol skin cleansing in long-term care (LTC) residents receiving vaccinations during the COVID-19 pandemic. Two medium-sized LTC homes participated in a cohort study, whereby one LTC used alcohol swab cleansing prior to resident vaccinations and the other did not. All residents received two doses of the BNT162b2 COVID-19 vaccine separated by an average (SD) 29.3 (8.5) days. The electronic chart records of participants were reviewed by researchers blinded to group allocation to assess for the presence of adverse events following immunization (AEFI), including reactogenicity, cellulitis, abscess, or systemic reactions. Log-binomial regression was used to compute risk ratios (with 95% confidence intervals) of an AEFI according to alcohol swab status. 189 residents were included, with a total of 56 AEFI between the two doses. The risk of reactogenicity (adjusted RR 0.54, 95% CI 0.17-1.73) or systemic reactions (adjusted RR 0.75, 95% CI 0.26-2.13) did not differ for the residents that received alcohol skin antisepsis compared to those that did not. There were no cases of cellulitis or abscess. This study did not demonstrate an elevated risk of AEFI in LTC residents receiving two doses of the BNT162b2 mRNA COVID vaccine without alcohol skin antisepsis.

A Quality Improvement Project Evaluating the Effects of Eat, Sleep, Console on Nurses and on Neonates With Neonatal Abstinence Syndrome.

OBJECTIVE: To improve neonatal outcomes through the implementation of an eat, sleep, console (ESC) assessment and change in hospital policy regarding the monitoring requirements for pharmacologic treatment of neonates with neonatal abstinence syndrome (NAS). DESIGN: Retrospective chart review and descriptive survey design. SETTING/LOCAL PROBLEM: A hospital in Northwestern Ontario decided to implement an evidence-informed practice change to better care for neonates with NAS. PARTICIPANTS: Neonates being screened for NAS during the Modified Finnegan Neonatal Abstinence Syndrome Scoring System (MFNASSS) protocol (n = 75) and ESC protocol (n = 40). Nurses working in the departments after the implementation of ESC were surveyed. MEASUREMENTS: Length of stay (LOS) and morphine administration by intervention status using unadjusted hazard and risk ratios, respectively. Descriptive statistics are also presented. A one-sample t test was completed for the nurses' perspectives survey questions. RESULTS: Reduced rate of LOS (HR = 1.66, 95% confidence interval [1.1, 2.51]) was observed for participants receiving the ESC intervention (4.53, SD = 1.94), compared to the MFNASSS control (7.45, SD = 6.35). Although the ESC group appeared to have a greater proportion of neonates administered morphine (42.5% ESC vs. 26.7% MFNASSS), the relative risk was not statistically significant (RR = 1.28, 95% confidence interval [0.95, 1.72]). Morphine doses per day were reduced in the ESC group (0.37, SD = 1.50) compared to the MFNASSS group (5.16, SD = 1.02). Overall, the nurses had a positive perspective on the policy change. CONCLUSION: ESC was successfully implemented in a Northwestern Ontario hospital. The overall LOS of neonates with NAS decreased. Nurses found the policy change to be safe and attainable.

SPSS macros to compare any two fitted values from a regression model.

In regression models with first-order terms only, the coefficient for a given variable is typically interpreted as the change in the fitted value of Y for a one-unit increase in that variable, with all other variables held constant. Therefore, each regression coefficient represents the difference between two fitted values of Y. But the coefficients represent only a fraction of the possible fitted value comparisons that might be of interest to researchers. For many fitted value comparisons that are not captured by any of the regression coefficients, common statistical software packages do not provide the standard errors needed to compute confidence intervals or carry out statistical tests-particularly in more complex models that include interactions, polynomial terms, or regression splines. We describe two SPSS macros that implement a matrix algebra method for comparing any two fitted values from a regression model. The !OLScomp and !MLEcomp macros are for use with models fitted via ordinary least squares and maximum likelihood estimation, respectively. The output from the macros includes the standard error of the difference between the two fitted values, a 95% confidence interval for the difference, and a corresponding statistical test with its p-value.

Opsonophagocytic activity against Streptococcus pneumoniae in Indigenous and non-Indigenous patients with severe chronic kidney disease immunized with 13-valent pneumococcal conjugate vaccine.

Adults with chronic kidney disease (CKD) are at high risk of pneumococcal infections and recommended to receive pneumococcal immunization. Some studies suggest that previous immunization with 23-valent pneumococcal polysaccharide vaccine (PPV23) may decrease the immunogenicity of 13-valent pneumococcal conjugate vaccine (PCV13). Via quantitation of serum IgG, IgM, and IgA specific to 7 pneumococcal serotypes (3, 6B, 9V, 14, 19A, 19F, 23F), we recently found that the response to PCV13 in previously PPV23 immunized patients with severe CKD was inferior compared to PPV23 naïve patients. As a follow-up of the previous study, we assessed the titers of opsonizing antibodies specific to 13 vaccine serotypes in sera collected as per the original clinical trial protocol. Opsonophagocytic activity (OPA) titers were determined in 57 previously PPV23-immunized (Group 1) and 72 PPV23-naïve (Group 2) patients pre- and post-PCV13 immunization (days 28 and 365). Pre-immunization, the geometrical mean titers (GMT) for 3/13 serotype-specific antibodies were significantly higher in Group 1 than in Group 2. PCV13 induced a significant GMT rise in both groups; an increase in 5/13 serotype-specific GMTs in Group 1 and 12/13 GMTs in Group 2 was present at one year post-immunization. Fold increase in GMTs by day 28 ranged between 2.4 (serotype 1) and 24.6 (serotype 6A) in Group 1, and between 4.3 (serotype 3) and 67.0 (serotype 6A) in Group 2. The fold increase was significantly larger in Group 2 than in Group 1 for serotypes 1, 4, 7F, and 18C. Patients of Indigenous ethnic background had significantly higher GMT for serotypes 6B and 23F at baseline, and for serotypes 5, 6B, 14, 18C, 19A, 19F, and 23F at Day 28 post-immunization, compared to the non-Indigenous counterpart. Conclusions: Patients with severe CKD developed functionally active pneumococcal antibodies post-PCV13 immunization. Previously administered PPV23 had a negative impact on several serotype-specific OPA responses to PCV13 that lasted for at least one year post-immunization. ClinicalTrials.gov ID: NCT02370069.

Distraction impairs drivers of all ages: A cross-sectional analysis of fatal crashes in the United States.

Objective: The objective of this study was to examine the association between distracted driving and crash responsibility across the whole age span after adjusting for several driver characteristics and the potential influence of alcohol and drugs.Methods: Using data from the Fatality Analysis Reporting System for the years 2010 to 2019, we estimated the association between distracted driving and crash responsibility in drivers (of passenger-type vehicles) aged 20 and older, with a confirmed blood alcohol concentration of zero, and who tested negative for drugs (n = 33,513). We operationalized crash responsibility as having one or more unsafe driving action (UDA) recorded.Results: In total, slightly under 9% of the drivers examined were coded as distracted. The most common UDA among distracted drivers was a failure to yield right of way (23.4% vs. 14.2% for non-distracted drivers). Driving distracted was associated with higher odds of an UDA for drivers of all ages (overall OR = 1.46, 95% CI = 1.24, 1.73).Conclusions: Distracted driving affects drivers of all ages. Given that distracted driving is highly preventable, we must increase our prevention efforts.

ERCP-Related Adverse Events in Primary Sclerosing Cholangitis: A Systematic Review and Meta-Analysis.

Background and Aims: While endoscopic retrograde cholangiopancreatography (ERCP) is a valuable diagnostic and therapeutic tool in primary sclerosing cholangitis (PSC), there is conflicting data on associated adverse events. The aims of this systematic review and meta-analysis are to (1) compare ERCP-related adverse events in patients with and without PSC and (2) determine risk factors for ERCP-related adverse events in PSC. Methods: Embase, PubMed, and CENTRAL were searched between January 1, 2000, and May 12, 2021. Eligible studies included adults with PSC undergoing ERCP and reported at least one ERCP-related adverse event (cholangitis, pancreatitis, bleeding, and perforation) or an associated risk factor. The risk of bias was assessed with the Newcastle-Ottawa scale and Cochrane Risk of Bias 2. Raw event rates were used to calculate odds ratios (ORs) and then pooled using random-effects models. Results: Twenty studies met eligibility criteria, of which four were included in a meta-analysis comparing post-ERCP adverse events in patients with PSC (n = 715) to those without PSC (n = 9979). We found a significant threefold increase in the 30-day odds of cholangitis in PSC compared to those without (OR 3.263, 95% CI 1.076-9.896; p=0.037). However, there were no significant differences in post-ERCP pancreatitis (PEP), bleeding, or perforation. Due to limitations in primary data, only risk factors contributing to PEP could be analyzed. Accidental passage of the guidewire into the pancreatic duct (OR 7.444, 95% CI 3.328-16.651; p < 0.001; I 2 = 65.0%) and biliary sphincterotomy (OR 4.802, 95% CI 1.916-12.033; p=0.001; I 2 = 73.1%) were associated with higher odds of PEP in a second meta-analysis including five studies. Conclusions: In the context of limited comparative data and heterogeneity, PSC patients undergoing ERCP have higher odds of cholangitis despite the majority receiving antibiotics. Additionally, accidental wire passage and biliary sphincterotomy increased the odds of PEP. Future studies on ERCP-related risks and preventive strategies are needed.

The efficacy of mindfulness-based cognitive therapy to improve depression symptoms and quality of life in individuals with memory difficulties and caregivers: A short report.

INTRODUCTION: Depression symptoms are common for older adults with memory difficulties and their caregivers. Mindfulness-based cognitive therapy (MBCT) reduces the risk of relapse in recurrent depression and improves depression symptoms. We explored recruitment and retention success and preliminary effect sizes of MBCT on depression and anxiety symptoms, as well as mindfulness facets, in individuals with memory difficulties and their caregivers. METHODS: A difficulty with memory group (DG) and caregiver group (CG) were randomized into either the MBCT intervention or waitlist control. After serving as controls, participants received the intervention. Mean pre-post changes by group were compared and effect sizes computed. Correlations between mindfulness facets and depression symptoms are also presented. RESULTS: Only 47% of the initial participants completed the study. The intervention did not have an effect on the outcome variables examined. However, improvements in non-judgmental scores were associated with reductions in the number of depression symptoms reported by DG participants (r = -0.90, 95% confidence interval [CI]: -0.98, -0.52) and CG participants (r = -0.76, 95% CI: -0.95, -0.19). Furthermore, improvements in awareness scores (r = -0.69, 95% CI: -0.93, -0.05) and level of burden (r = 0.87, 95% CI: 0.49, 0.97) also significantly correlated with reduced depression symptoms in the CG group. CONCLUSIONS: By determining preliminary MBCT effect sizes in individuals with memory difficulties and their caregivers, research with larger, controlled samples is now justified to determine the true effects of MBCT in these populations.

The SIMARD-MD is not an Effective Driver Screening Tool for Determining Fitness-To-Drive.

BACKGROUND: Studies have reported poor sensitivity and specificity of the Screen for the Identification of Cognitively Impaired Medically At-Risk Drivers, a modification of the DemTech (SIMARD-MD) to screen for drivers with cognitive impairment. The purpose of this study was to determine whether the SIMARD-MD can accurately predict pass/fail on a road test in drivers with cognitive impairment (CI) and healthy drivers. METHODS: Data from drivers with CI were collected from two comprehensive driving assessment centres (n=86) and compared with healthy drivers (n=30). All participants completed demographic measures, clinical measures, and a road rest (pass/fail). Analyses consisted of correlations between the SIMARD-MD and the other clinical measures, and a receiver-operating-characteristic (ROC) curve to determine the predictive ability of the SIMARD-MD. RESULTS: All healthy drivers passed the road test compared with 44.2% of the CI sample. On the SIMARD-MD, the CI sample scored significantly worse than healthy drivers (p < .001). The ROC curve showed the SIMARD-MD, regardless of any cut-point, misclassified a large number of CI individuals (AUC=.692; 95% CI = 0.578, 0.806). CONCLUSIONS: Given the high level of misclassification, the SIMARD-MD should not be used with either healthy drivers or those with cognitive impairment for making decisions about driving.

The additive effects of alcohol and benzodiazepines on driving.

OBJECTIVES: To examine the relationship between the combination of alcohol and benzodiazepines and the risk of committing an unsafe driver action. METHODS: We used data from the Fatality Analysis Reporting System (1993-2006) on drivers aged 20 or older who were tested for both alcohol and drugs. Using a case-control design, we compared drivers who had at least one unsafe driver action (UDA; e.g., weaving) recorded in relation to the crash (cases) to drivers who did not (controls). RESULTS: Drivers who tested positive for intermediate- and long-acting benzodiazepines in combination with alcohol had significantly greater odds of a UDA compared to those under the influence of alcohol alone, up to blood alcohol concentrations (BACs) of 0.08 and 0.05 g/100 ml, respectively. The odds of a UDA with short-acting benzodiazepines combined with alcohol were no different than for alcohol alone. CONCLUSIONS: This study demonstrates that the combination of alcohol and benzodiazepines can have detrimental effects on driving beyond those of alcohol alone. By describing these combined effects in terms of BAC equivalencies, this study also allows for the extrapolation of simple, concrete concepts that communicate risk to the average benzodiazepine user.

Age and engine displacement are associated with unsafe motorcycle rider actions.

BACKGROUND: Our goal was to examine the relationship between age and engine displacement in cubic centimeters (CCs) and crash responsibility. METHODS: Male motorcyclists, aged 16-94, involved in a fatal crash in the United States (1987-2015) who tested negative for both drugs and alcohol were included. Employing a case control design, cases had committed one or more Unsafe Motorcyclist Actions (UMAs), the proxy measure of responsibility; controls had no UMAs recorded. Odds ratios were computed via multinomial regression examining the effect of motorcyclists' age and motorcycle displacement (up to 1500 CCs, in 250 CC increments) on crash responsibility by any UMA and top three individual UMAs committed. RESULTS: A total of 19,166 motorcyclists met our inclusion criteria. Increased displacement was observed in older motorcyclists and in more recent crashes. Fifty-six percent of motorcyclists committed one or more UMAs (n = 10,743). The top three individual UMAs were: Speeding (35%, n = 6,728), Weaving (24%, n = 3,269), and Erratic Operation (6%, n = 1,162). Odds ratios for committing any UMA were the greatest for riders on 750 CC motorcycles, followed closely by 500 and 1000 CC motorcycles. By 1250 CCs the effect of displacement on rider crash responsibility (any UMA) was no longer statistically significant. Typically, younger ages (e.g., 20-30) on motorcycles with 500-1000 CCs were associated with the highest odds of either speeding, weaving, or erratic riding compared to similar aged riders on 250 CC motorcycles. Exceptions were observed, for example riders at 70 years of age on 1500 CCs having higher odds of speeding than younger riders on equivalent CC motorcycles. CONCLUSION: Education and legislative measures should be considered. Educationally, the development of training interventions focusing on control, stability, and breaking differences with more powerful motorcycles (750 to 1250 CCs) is needed. Legislatively, licensing tiers could be employed based on displacement and educational requirements. Education and legislative measures could help to curb the trend seen between high-powered motorcycles and crash responsibility.

Epidemiologic features of medical emergencies in remote First Nations in northern Ontario: a cross-sectional descriptive study using air ambulance transport data.

BACKGROUND: For about 25 000 Ontarians living in remote northern First Nations communities, seeing a doctor in an emergency department requires flying in an airplane or helicopter. This study describes the demographic and epidemiologic characteristics of patients transported from these communities to access hospital-based emergency medical care. METHODS: In this cross-sectional descriptive study, we examined primary medical data on patient transportation from Ornge, the provincial medical air ambulance service provider, for 26 remote Nishnawbe Aski Nation communities in northern Ontario from 2012 to 2016. We described these transports using univariate descriptive statistics. RESULTS: Over the 5-year study period, 10 538 patients (mean 2107.6 per year) were transported by Ornge from the 26 communities. Transport incidence ranged from 9.2 to 9.5 per 100 on-reserve population per year. Women aged 65 years or more had the highest transport incidence (25.9 per 100). Girls aged 5-9 years had the lowest mean incidence (2.1 per 100). Gastrointestinal issues accounted for 13.3% of transfers. Neurologic issues, respiratory issues and trauma each accounted for about 11% of transfers, and cardiac issues for 9.6%. Patients with obstetric issues accounted for 7.6% of transfers per year, and toxicologic emergencies for 7.5%. INTERPRETATION: This study provides the epidemiologic foundation to improve emergency care and emergency transport from remote First Nation communities in Ontario.

Using the Resident Assessment Instrument-Mental Health (RAI-MH) to determine levels of care for individuals with serious mental illness.

This paper outlines the development of an algorithm to determine appropriate levels of care (LOC) for individuals with a serious mental illness (SMI). The algorithm, drew on several domains of the Resident Assessment Instrument-Mental Health (RAI-MH) to support a statistical model that would explain a maximum of variance with the gold standard, a consensus-based global rating of required LOC. The RAI-MH model explained 67.5% of the variance. The validity of the model was further examined by determining how the discrepancy between the current and predicted levels of care related to psychiatric outcomes. The results demonstrated that undersupported clients experienced significant negative psychiatric outcomes compared to clients receiving adequate care. Although the model based on the RAI-MH is not perfect, the results warrant further research to determine its usefulness in predicting required LOC.

Age modifies the association between driver's body mass index and death following motor vehicle crashes.

OBJECTIVE: We explored the association between body mass index (BMI) and the odds of a driver being fatally injured in a motor vehicle crash (MVC) after controlling for driver, crash, and vehicle factors known to independently contribute to injury severity. We hypothesized that BMI would be related to risk of fatal injury after controlling for other risk factors but that BMI would also interact with age. METHOD: We analyzed crashes involving 2 passenger type vehicles (1998-2015) from the Fatality Analysis Reporting System using binary logistic regression (with generalized estimating equations) to compute odds ratios and 95% confidence intervals of fatality by BMI status. RESULTS: Our results indicate that BMI status confers varying levels of risk at different ages. For example, a very low BMI of 18 increased the odds of fatality (relative to BMI = 21.75) more at age 85 (adjusted odds ratio [aOR] = 1.17, 95% confidence interval [CI], 1.09, 1.26) than at age 25 (aOR = 1.03, 95% CI, 1.01, 1.06). Similarly, a very high BMI of 42.5 increased the odds of fatality (relative to BMI = 21.75) more at age 85 (aOR = 2.17, 95% CI, 1.64, 2.87) than at age 25 (aOR = 1.33, 95% CI, 1.21, 1.45). Conversely, a moderate BMI of 27.5 was protective for drivers aged 85 (aOR = 0.94, 95% CI, 0.88, 0.99) but had no effect for drivers aged 25 (aOR = 1.00, 95% CI, 0.98, 1.02). We also found that a higher BMI was associated with higher odds of wearing a seat belt improperly or not wearing one at all. CONCLUSION: The relationship between BMI and fatality risk needs to be considered by policymakers, public health officials, and vehicle manufacturers to ensure that vehicles are safe for all occupants regardless of their weight, size, or shape.