When should the driver with a history of substance misuse be allowed to return to the wheel? A review of the substance misuse section of the Australian national guidelines.

Assessing fitness to drive in applicants with a historical or current substance use disorder presents a specific clinical challenge. The Australian guidelines require evidence of remission and absence of cognitive change when considering applications for re-licensing driver or individuals applying to reengage in safety-sensitive work. This paper reviews some of the clinical and biochemical indicators that determine whether a particular person is in 'remission' and meets the criteria for return to driving or other safety-sensitive occupation. It provides an overview of the challenges in establishing an evidence-based approach to determining fitness for safety critical activities. There is no internationally accepted definition of 'remission'. Review of the literature and examination of assessment protocols from other national jurisdictions are available for alcohol and the more important drugs of interest in road safety. Assessing fitness to drive when there is a history of substance misuse and/or substance use disorders is a complex issue that requires assessment of biomarkers, clinical findings and clinical assessment before the person returns to driving. We propose that hair testing provides a reliable and reproducible way to demonstrate remission and provide cost-effective monitoring. Standardised psychological tests could provide a reproducible assessment of the cognitive effects of drug use and suitability to resume driving. We recommend that AustRoads amend the national guidelines to reflect an evidence-based approach to assessing fitness to drive after conviction for offences related to alcohol and drug use.

Guidance note: risk management of workers with medical electronic devices and metallic implants in electromagnetic fields.

Medical electronic devices and metallic implants are found in an increasing number of workers. Industrial applications requiring intense electromagnetic fields (EMF) are growing and the potential risk of injurious interactions arising from EMF affecting devices or implants needs to be managed. Potential interactions include electromagnetic interference, displacement, and electrostimulation or heating of adjacent tissue, depending on the device or implant and the frequency of the fields. A guidance note, which uses a risk management framework, has been developed to give generic advice in (a) risk identification--implementing procedures to identify workers with implants and to characterise EMF exposure within a workplace; (b) risk assessment--integrating the characteristics of devices, the anatomical localisation of implants, occupational hygiene data, and application of basic physics principles; and (c) risk control--advising the worker and employer regarding safety and any necessary changes to work practices, while observing privacy.

Diseases of modern living: neurological changes associated with mobile phones and radiofrequency radiation in humans.

Health effects of radiofrequency radiations (RFR) including mobile phone technology and the adequacy of their safety standards remain uncertain. Case reports of peripheral neurological effects of RFR describe mainly disturbances of noxious sensation (dysaesthesia). Cases associated with other RFR sources as well as mobile phone technology are examined seeking insights into neurophysiological mechanisms and safety levels. Cases have arisen after exposure to much of the frequency range (low MHz to GHz). In some instances symptoms are transitory, but may be lasting in others. After very high intensity exposures nerves may be grossly injured. However, after lower intensity exposures which may result in dysaesthesia, ordinary nerve conduction studies demonstrate no abnormality although current perception threshold studies may. Only a small proportion of similarly exposed persons develop symptoms. The role of modulations (e.g. pulses) needs clarification. Some of these observations are not consistent with the prevailing hypothesis that all health effects of RFR arise from thermal mechanisms. It is concluded that RFR from mobile phones can cause peripheral neurophysiological changes in some persons. The effects occur at exposure levels below the present safety levels for RFR. Possible non-thermal mechanisms are discussed and may point to future directions of research.

Decreased survival for childhood leukemia in proximity to television towers.

Previously, an increased risk of childhood leukemia was identified among children who resided in an inner ring (radius -4 km) of 3 municipalities surrounding television towers, compared with children who resided in an outer ring (radius approximately 4-12 km) of 6 municipalities surrounding, but farther away from, the towers, which are situated in North Sydney, Australia. In the current study, the authors examined the survival experience of these children for all childhood leukemias, and for acute lymphatic leukemia (International Statistical Classification of Diseases and Related Health Problems, 9th revision [ICD-9] rubric 204.0) in particular. Of 123 cases of acute lymphatic leukemia, 29 cases (16 of whom died) were in the inner ring of municipalities nearest the towers, and 94 cases (34 of whom died) occurred in the outer, more-distant ring. There was a significant difference in survival rates between the 2 groups (log-rank test, p = 0.03; Wilcoxon, p = 0.05). The 5-yr survival in the inner ring of municipalities was 55%, and in the outer ring was 71% (i.e., subjects in the inner ring were 23% less likely to survive than those in the outer ring); at 10 yr, survival in the inner and outer rings was 33% and 62%, respectively. Following adjustment, the mortality rate ratio that the authors used to compare the inner ring with the outer ring was 2.1 (95% confidence interval = 1.1, 4.0). There was an association between residential proximity to the television towers and decreased survival among cases of childhood leukemia in North Sydney, Australia.

New medical standards for drivers.

BACKGROUND: The national standards for assessing private and commercial vehicle drivers have recently been revised and combined into a single publication 'Assessing Fitness to Drive', published by Austroads. The new publication provides greater clarity of medical criteria for general practitioners and specialists and also details useful management guidelines. OBJECTIVE: This article introduces GPs to the new standards, outlines the key changes and implications for practice and highlights several medical, legal and ethical issues. DISCUSSION: Assessment of fitness to drive is a common issue in patient management and one that carries significant health, safety and lifestyle consequences both for the drivers themselves and other road users.

The Inquiry into the Waterfall train crash: implications for medical examinations of safety-critical workers.

The implications arising from the Inquiry into the Waterfall train crash for medical examinations of safety-critical workers are discussed. Examinations need to be appropriate for the level of risk in the job and apply current medical thinking. A careful balance is required between the various legal obligations, including duty of care, disability discrimination and privacy. The frequency of examinations depends on a combination of medical, economic and logistical factors. Health professionals who conduct examinations should be familiar with the occupation of the person being examined. Ethical relationships with the worker's general practitioner or specialist(s) must be observed. The procedures associated with the examinations are as important in achieving safety as the actual examinations. These include complying with relevant standards; providing all relevant documentation with a referral for an examination; acting on the doctor's report appropriately; and auditing the process.

Neurological effects of radiofrequency radiation.

BACKGROUND: The health effects of radiofrequency radiation (RFR) and the adequacy of the safety standards are a subject of debate. One source of human data is case reports regarding peripheral neurological effects of RFR, mainly noxious sensations or dysaesthesiae. AIM: To investigate health effects, neurophysiological mechanisms and safety levels for RFR. METHODS: We conducted a literature search for case reports and case series associated with mobile phone technology as well as other RFR sources using specific search terms on PubMed. RESULTS: We identified 11 original articles detailing case reports or case series and matching the search criteria. Five of the identified papers were written by at least one of the authors (B.H. or R.W.). CONCLUSIONS: Cases have arisen after exposure to much of the radiofrequency range. In some cases, symptoms are transitory but lasting in others. After very high exposures, nerves may be grossly injured. After lower exposures, which may result in dysaesthesia, ordinary nerve conduction studies find no abnormality but current perception threshold studies have found abnormalities. Only a small proportion of similarly exposed people develop symptoms. The role of modulations needs clarification. Some of these observations are not consistent with the prevailing hypothesis that all health effects of RFR arise from thermal mechanisms.