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[Pharmacists' Advice about Driving for Diabetic Patients].
Satake, M
Yakugaku zasshi : Journal of the Pharmaceutical Society of Japan. 2017;(3):329-335
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Abstract
In November 2013, the Japanese Ministry of Health, Labour and Welfare issued a directive that required the revision of the package inserts of 13 substances whose consumption carries risks associated with driving and the operation of machinery due to their side effects, such as dizziness. Medical personnel are required to remind patients taking these drugs about the risks, but the abovementioned directive did not apply to any antidiabetic drugs at that point. In January 2014, it was decided that patients should "pay attention while driving and at the workplace" when taking any antidiabetic drugs. This point is mentioned in the "important precautions" section of the drugs' package inserts. Since the revised Road Traffic Law was enacted in June 2014, the penalty for car accidents caused by a lack of awareness of hypoglycemia has increased. It has therefore become essential for medical personnel to instruct diabetic patients how to avoid falling unconscious due to hypoglycemia during driving. Patients taking antidiabetic drugs that are categorized as high-risk drugs are required to take an extra set of precautions and these are important for preventing severe hypoglycemia as well as reducing patients' cardiovascular risk. For more than 20 years, my pharmacy has been giving annual intensive counseling on hypoglycemia to diabetic patients. This counseling includes reminding patients about preventative measures, the risks associated with driving, and the need to keep a source of sugar in their cars. Only about 10% of diabetic patients keep a source of sugar in their cars.
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[DIABETES AND ROAD ACCIDENTS].
Haim, A, Shimshi, M, Hershkovitz, E
Harefuah. 2016;(11):691-696
Abstract
Many countries restrict people with diabetes from driving. These restrictions are based on the assumption that drivers with diabetes are prone to road accidents more than the general population. There are factors that can affect the driving ability of people with diabetes that are related to the immediate effects of the disease such as hypoglycemia, hyperglycemia or disease complications such as retinopathy or neuropathy. Restrictions on driving of people with diabetes have implications both on the patients and the society. In this review we will examine the data available in literature on the relationship between diabetes and involvement in road accidents.
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Psychological distress following a motor vehicle crash: A systematic review of preventative interventions.
Guest, R, Tran, Y, Gopinath, B, Cameron, ID, Craig, A
Injury. 2016;(11):2415-2423
Abstract
INTRODUCTION Psychological distress following a motor vehicle crash (MVC) is prevalent, especially when the person sustains an associated physical injury. Psychological distress can exhibit as elevated anxiety and depressive mood, as well as presenting as mental disorders such as Post Traumatic Stress Disorder (PTSD) or Major Depressive Disorder (MDD). If unmanaged, psychological distress can contribute to, or exacerbate negative outcomes such as social disengagement (e.g., loss of employment) and poor health-related quality of life, as well as contribute to higher costs to insurers. This systematic review summarises current research concerning early psychological intervention strategies aimed at preventing elevated psychological distress occurring following a MVC. METHOD A systematic review of psychological preventative intervention studies was performed. Searches of Medline, Embase, PsychINFO, Web of Science and Cochrane Library were used to locate relevant studies published between 1985 and September 2015. Included studies were those investigating MVC survivors who had received an early psychological intervention aimed at preventing psychological distress, and which had employed pre- and post- measures of constructs such as depression, anxiety and disorders such as PTSD. RESULTS Searches resulted in 2608 records. Only six studies investigated a psychological preventative intervention post-MVC. Interventions such as injury health education, physical activity and health promotion, and therapist-assisted problem solving did not result in significant treatment effects. Another six studies investigated psychological interventions given to MVC survivors who were assessed as sub-clinically psychologically distressed prior to their randomisation. Efficacy was varied, however three studies employing cognitive behaviour therapy (CBT) found significant reductions in psychological distress compared to wait-list controls. CONCLUSION Psychological interventions aimed at preventing psychological distress post-MVC are limited, often involving small samples, with subsequent poor statistical power and subsequent high risk of bias. These factors make it difficult to draw conclusions, however CBT appears encouraging and therefore worthy of consideration as a preventative intervention.
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Mobility and safety issues in drivers with dementia.
Carr, DB, O'Neill, D
International psychogeriatrics. 2015;(10):1613-22
Abstract
Although automobiles remain the mobility method of choice for older adults, late-life cognitive impairment and progressive dementia will eventually impair the ability to meet transport needs of many. There is, however, no commonly utilized method of assessing dementia severity in relation to driving, no consensus on the specific types of assessments that should be applied to older drivers with cognitive impairment, and no gold standard for determining driving fitness or approaching loss of mobility and subsequent counseling. Yet, clinicians are often called upon by patients, their families, health professionals, and driver licensing authorities to assess their patients' fitness-to-drive and to make recommendations about driving privileges. We summarize the literature on dementia and driving, discuss evidenced-based assessments of fitness-to-drive, and outline the important ethical and legal concerns. We address the role of physician assessment, referral to neuropsychology, functional screens, dementia severity tools, driving evaluation clinics, and driver licensing authority referrals that may assist clinicians with an evaluation. Finally, we discuss mobility counseling (e.g. exploration of transportation alternatives) since health professionals need to address this important issue for older adults who lose the ability to drive. The application of a comprehensive, interdisciplinary approach to the older driver with cognitive impairment will have the best opportunity to enhance our patients' social connectedness and quality of life, while meeting their psychological and medical needs and maintaining personal and public safety.
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5.
[Diabetes and driving: evidence and recommendations].
Senra Moniz, C, Alves Serra, F, Costa Ferreira, R, Vasconcelos, C, Machado Saraiva, A
Acta medica portuguesa. 2013;(4):428-32
Abstract
In the last years there was an increasing concern about driving and some medical conditions. Diabetes is one of the diseases associated with road traffic accidents. This increased risk is associated with hypoglycemia and diabetes complications such as: retinopathy, cataracts and neuropathy. In order to avoid car crashes patients must follow some rules like carrying some sugar source in their vehicle, always measure blood glycemia before start driving, never begin an extended drive with blood glucose less than 90 mg/dl without prophylactic carbohydrate consumption, stop the vehicle as soon any of the symptoms of low blood glucose are experienced and measure and treat the blood glucose level. In Portugal there are new rules for diabetic drivers since January 2013. Group 1 drivers are considerer unfit to drive if they have severe or recurrent hypoglycemia. Group 2 drivers need to present a medical report certificating they have good diabetes control, have not had any severe or recurrent hypoglycemia in the last twelve months and there aren't any other diabetes complications.
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Virtual reality treatment of posttraumatic stress disorder due to motor vehicle accident.
Wiederhold, BK, Wiederhold, MD
Cyberpsychology, behavior and social networking. 2010;(1):21-7
Abstract
Posttraumatic stress disorder (PTSD) is a complex, multifaceted disorder encompassing behavioral, emotional, cognitive, and physiological factors. Although PTSD was only codified in 1980, there has been an increasing interest in this area of research. Unfortunately, relatively little attention has been given to the psychological treatment of motor vehicle accident survivors, which is remarkable because vehicular collisions are deemed the number one cause of PTSD. As the emotional consequences of vehicular collisions prevail, so does the need for more effective treatments. Randomized controlled clinical trials have identified exposure-based therapies as being the most efficacious for extinguishing fears. One type of exposure-based treatment, called virtual reality exposure therapy (VRET), provides a safe, controlled, and effective therapeutic alternative that is not dependent on real-life props, situations, or even a person's imagination capabilities. This modality, while relatively new, has been implemented successfully in the treatment of a variety of anxiety disorders and may offer a particularly beneficial and intermediary step for the treatment of collision-related PTSD. In particular, VRET combined with physiological monitoring and feedback provides a unique opportunity for individuals to objectively recognize both anxiety and relaxation; learn how to manage their anxiety during difficult, albeit simulated, driving conditions; and then transfer these skills onto real-life roadways.
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Psychobiology of posttraumatic stress disorder in pediatric injury patients: a review of the literature.
Langeland, W, Olff, M
Neuroscience and biobehavioral reviews. 2008;(1):161-74
Abstract
Research suggests that about a quarter to a third of children with traffic-related injuries develop posttraumatic stress disorder (PTSD). Early symptoms of PTSD have been found to predict poor mental and physical outcome in studies of medically injured children. However, these symptoms are rarely recognized by physicians who provide emergency care for these children. In addition, there is insufficient knowledge about predictors of posttraumatic stress symptoms in this specific pediatric population. Early identification of those children at particular risk is needed to target preventive interventions appropriately. After some introducing remarks on the classification and the nature of posttraumatic stress reactions, current research findings on psychological and biological correlates of PTSD in pediatric injury patients are presented. The particular focus in this paper is on the neurobiological mechanisms that influence psychological responses to extreme stress and the development of PTSD. Continued study of the psychobiology of trauma and PTSD in pediatric injury patients, both in terms of neurobiology and treatment is needed.
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Health and road transport in Pakistan.
Hyder, AA, Ghaffar, AA, Sugerman, DE, Masood, TI, Ali, L
Public health. 2006;(2):132-41
Abstract
OBJECTIVE The 1998 Global Burden of Disease Study estimated that road traffic injuries (RTIs) will become the third leading cause of lost disability-adjusted life years, with two-thirds of the deaths occurring in the least developed nations. Moreover, automobile-based transport systems are associated with air pollution (lead toxicity, asthma and greenhouse gas accumulation), noise disturbances, physical inactivity and obesity. STUDY DESIGN This study (1) reviewed road transport literature in Pakistan and the impacts on health outcomes; (2) examined health policies to assess their focus on transport-related health problems; and (3) identified policy gaps for future research. METHODS A methodological review of the literature on direct and indirect effects of road transportation in Pakistan. This review includes government documents, memos, statements and draft policies as well as relevant articles indexed in MEDLINE. RESULTS A systematic review revealed no approved transport policy in Pakistan, despite three national health policy documents. The Health Chapter of the 9th Five Year Plan appreciates the grave threat of unchecked RTI, but fails to offer specific policy interventions. Despite ambitious plans by the Pakistan Environmental Protection Agency, actual projects and their implementation remain scarce, resulting in ever-increasing air pollution. The health impact of lead toxicity, noise pollution and RTIs remain high, while obesity is on the rise. CONCLUSION The increasing health impact of road transport on 140 million people calls for immediate policy action. Government agencies must intervene effectively to establish monitoring and decentralised enforcement nationwide, while simultaneously supporting alternative modes of transportation.
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Drugs of abuse monitoring in blood for control of driving under the influence of drugs.
Moeller, MR, Kraemer, T
Therapeutic drug monitoring. 2002;(2):210-21
Abstract
Driving under the influence of drugs is an issue of growing concern in the industrialized countries as a risk and a cause for road accidents. In forensic toxicology, the increasing number of samples for determination of drugs in blood is mainly due to zero-tolerance laws in several countries and well-trained police officers who can better recognize drivers under the influence of drugs of abuse. This review describes procedures for detection of the following drugs of abuse in whole blood, plasma, and serum: amphetamine, methamphetamine, 3,4-methylenedioxy methamphetamine (MDMA), N-ethyl-3, 4-methylenedioxyamphetamine (MDEA), 3,4-methylenedioxyamphetamine (MDA), cannabinoids (delta-9-tetrahydrocannabinol [THC], 11-hydroxy-delta-9-THC, 11-nor-9-carboxy-delta-9-THC), cocaine, benzoylecgonine, ecgonine methyl ester, cocaethylene, the opiates (heroin, 6-monoacetylmorphine, morphine, or codeine), and methadone as well as gamma-hydroxybutyric acid (GHB), lysergic acid diethylamide (LSD), phencyclidine (PCP), and psilocybin/psilocin. For many of the analytes, sensitive immunologic methods for screening are available. Gas chromatography-mass spectrometry (GC-MS) is still the state-of-the-art method for confirmatory analysis or for screening and confirmation in one step. Liquid chromatography-mass spectrometry (LC-MS) procedures for such purposes are also included in this review. Basic data about the biosample assayed, internal standard, workup, GC or LC column and mobile phase, detection mode, reference data, and validation data of each procedure are summarized in two tables.