Working with cognitively impaired drivers: Legal issues for mental health professionals to consider

Introduction

Mental health professionals are gatekeepers of patient confidentiality. Yet, confidentiality held too strictly, by allowing a potentially dangerous driver to assume control of a car, endangers society. Recent court cases have mandated that mental health professionals must warn those who may be potentially harmed by patients. In spite of this, disagreements linger as to whether it is the responsibility of governmental agencies or mental health professionals to decide who is unfit to operate a vehicle because of cognitive impairment. Methods: This article addresses the legally relevant considerations when working with cognitively compromised individuals who operate a motor vehicle. Legal issues surrounding confidentiality, patient rights, foreseeable risk, and the duty to warn and protect are presented in order to understand their relationship to recent court rulings.

Impact on industry

The impact on the mental health care industry includes not only concerns about increased insurance premiums or costs due to alleged negligence or litigation expenses secondary to failure to ensure the safety of an impaired client under their care. Mental health care providers are aware that the welfare of clients with impairment to cognitive decision making ability may require unique considerations for safety such as ensuring safe and appropriate transportation.     

Water security as a challenge for the sustainability of La Serena-Coquimbo conurbation in northern Chile: global perspectives and adaptation

The aim of this study is to address the problem of balance between water scarcity and sustainability, which are the key components of water security of cities located in arid lands, particularly those under constant expansion and population growth. In this paper, we have highlighted the problem of water security for the sustainability of the La Serena-Coquimbo conurbation (LSCC). The coastal LSCC is located at the outlet of the Elqui River basin, in the southern edge of the Chilean Atacama Desert. We have analyzed the available information including drinking water production and consumption data, groundwater levels, precipitation data and population data. Between the years 2009 and 2013 the total water consumption for the area has significantly increased. On the other hand, there has been a significant decrease trend in the precipitations and the groundwater levels show a decrease of about 30 m between the years 1995 and 2014. In a few years, this urban area could face a general water scarcity problem if the drought conditions remain unchanged and if the water demand trend for the agricultural, mining and drinking water continues its increasing. The cities located in the arid lands are particularly vulnerable to water scarcity because their populations are highly concentrated and requires reliable supplies of water to make possible human and economic activities. We discuss how adaptation of the arid land urban areas to water scarcity requires a range of solutions, including economic incentives, regulatory measures, and technology.     

An experimental study of the effect of diet on the fatty acid profiles of the European Cuttlefish (<Emphasis Type="Italic">Sepia officinalis</Emphasis>)

Fatty acid analysis is an alternative dietary investigation tool that complements the more traditional techniques of stomach content and faecal analysis that are often subject to a wide range of biases. In applying fatty acid analysis to ecosystem studies, it is important to have an understanding of the effect diet has on the fatty acid profile of the predator. A feeding experiment, using crustacean and fish as prey for the European cuttlefish Sepia officinalis, was conducted to evaluate the effect of prey fatty acids on the fatty acid profile of this marine predator. Cuttlefish were fed on a fish diet for the first 29 days, and then changed to a crustacean diet for a further 28 days. Another group of cuttlefish was fed on a crustacean diet for the first 29 days, and then changed to a fish diet for a further 28 days. An analysis of the cuttlefish digestive gland showed that the fatty acid profile reflected that of the prey, with cuttlefish on a crustacean diet being clearly distinguishable from the cuttlefish on a fish diet. Cuttlefish fed on a fish diet for 29 days prior to the switch in diet were comparatively higher in 16:0, AA, 20:1ω9, DPA6, DHA, 22:4ω6 and DPA3 than those fed on crustaceans. Cuttlefish fed on a crustacean diet for 29 days prior to the switch in diet were comparatively higher in 17:1ω8, 18:1ω9, 18:2ω6, 18:1ω7, EPA and 20:2ω6 than those fed on fish. Following a change in diet, the fatty acid profile of the cuttlefish digestive gland reflected that of the new diet within 14 days. The results confirm that the fatty acid profile of the cuttlefish digestive gland clearly reflects the profile of its recent diet. It also shows that the digestive gland may not be an organ that accumulates dietary lipids for long-term storage, but rather is an organ where lipids are rapidly being turned over and potentially excreted.     

An economic evaluation of a participatory ergonomics process in an auto parts manufacturer

Problem

We assess the costs and consequences of a participatory ergonomics process at a Canadian car parts manufacturer from the perspective of the firm.

Method

Regression modeling was used with interrupted time series data to assess the impact of the process on several health measures. Consequences were kept in natural units for cost-effectiveness analysis, and translated into monetary units for cost-benefit analysis.

Results

The duration of disability insurance claims and the number of denied workers' compensation claims was significantly reduced. The cost-effectiveness ratio is $12.06 per disability day averted. The net present value is $244,416 for a 23-month period with a benefit-to-cost ratio of 10.6, suggesting that the process was worth undertaking (monetary units in 2001 Canadian dollars).

Discussion

Our findings emphasize the importance of considering a range of outcomes when evaluating an occupational health and safety intervention.

Impact on industry

Participatory ergonomics process can be cost-effective for a firm.     

An epidemiologic comparison of injuries presenting to a pediatric emergency department and local urgent care facilities

Problem

The objective of this study was to compare the epidemiology of injuries presenting to emergency department (ED) and urgent care (UC) facilities of a single, NEISS-affiliated hospital.

Method

Patient medical records (n = 36,811) were used to compare injury incidence, injury characteristics, and demographic characteristics between the ED, on-site UC, and off-site UC during 2006.

Results

ED presentations were more likely to be open wounds and motor vehicle-related compared to on-site UC presentations. ED presentations were more likely to be system wide/late effects, be made by an African American, or be paid through Medicaid compared to off-site UC presentations. On-site UC presentations were more likely to be made by an African American or be paid through Medicaid compared to off-site UC presentations.

Discussion

ED and UC injury characteristics and patient demographics differ. With no nationally-representative UC injury surveillance, current research likely underestimates injury incidence and presents skewed profiles. Impact on Industry: This article adds insight into the generalizability of ED-based injury surveillance to UC injuries.     

Occupational injuries of immigrant and Finnish bus drivers

Problem

With baby boomers reaching retirement age, Western countries may need more immigrant workers to ensure productivity. Many studies have suggested a higher occupational injury frequency among immigrant workers, which could considerably reduce their contribution to society. The aim of this study was to examine whether immigrant workers have a higher injury frequency compared to Finnish workers when performing the exact same tasks under the same working conditions.

Method

A total of 176 Finnish and 130 immigrant bus drivers were asked about their occupational injuries during the past 12 months via a questionnaire. In addition, the data contained 134 injuries reported by the transport firm to an insurance company.

Results

There was no significant difference in reporting occupational injuries by self-reporting or by company-records. Because there were more accident-repeaters among Finnish drivers, their injury frequency (114) was higher than that of immigrant drivers (78).

Application/Impact

This study showed that immigrant workers did not have a higher injury frequency than other workers when they worked in the exact same conditions. Immigrant workers can work as safely as native-Finnish workers, when their working conditions and job contracts are at the same level as those of the original population. Immigrant workers can compensate for the shortage of workforce caused by an aging population.