Improved recovery of repeat intoxicated drivers using fingernails and blood spots to monitor alcohol and other substance abuse

Objectives: This study reports the results of a pilot program in Kenosha County that used a combination of direct biomarkers extracted from blood spots and nails to monitor repeat intoxicated drivers for their use of alcohol and drugs with a detection window spanning from 3 weeks to several months. The objectives were to test whether the direct biomarkers phosphatidylethanol (PEth), ethylglucuronide (EtG), and 5 drug metabolites would (1) help assessors obtain a more objective evaluation of repeat offenders during the assessment interview, (2) allow for timely identification of relapses and improve classification of drivers into risk categories, and (3) predict recidivism by identifying offenders most likely to obtain a subsequent operating while intoxicated (OWI) offense within 4 years of enrollment in the program.

Methods: All (N = 261) repeat offenders were tested using PEth obtained from blood spots and EtG obtained from fingernails; 159 participants were also tested for a 5 drugs of abuse nail panel. Drivers were tested immediately after the assessment interview (baseline) and at 3, 6, 9, and 12 months after baseline. Based on biomarker results and self-reports of abstinence, offenders were classified into different risk categories and required to follow specific testing timelines based on the program's decision tree.

Results: The baseline analysis shows that 60% of drivers tested positive for alcohol biomarkers (EtG, PEth, or both) at the assessment interview, with lower detection rates (0–11%) for the 5 drug metabolites. The comparison of biomarkers results to self-reports of abstinence identified 28% of all offenders as high risk and assigned them to more frequent testing and more intense monitoring. The longitudinal analysis shows that 56% (completers) of participants completed the program successfully and the remaining 44% (noncompliant) terminated prematurely. Two thirds (68%) of the completers were able to reduce or control their drinking and one third relapsed at least one time during their mandated monitoring periods. After a brief intervention by the assessors, 79% of relapsers tested negative for biomarkers in their repeat tests. The rearrest analysis showed that offenders classified in the noncompliant and relapsers groups were 7 times more likely to receive a new OWI 4 years after enrollment compared to drivers classified as abstainers or controllers. Refractory drivers were monitored the longest and reported no subsequent rearrests.

Conclusion: These findings demonstrate the benefits of more individualized interventions with repeat OWI offenders and calls for further development of multimodal approaches in traffic medicine including those that use direct alcohol biomarkers as evidence-based practices to reduce recidivism.     

Prevalence and concentrations of drugs in older suspected drugged drivers

Objective: Older drivers are somewhat more likely to be involved in car crashes than middle-aged drivers but less likely to be involved than younger drivers. This study aimed to assess the extent of drug use in older suspected drunk and drugged drivers, with respect to which drugs were detected and at which concentrations.

Methods: Blood samples from older suspected drunk and drugged drivers taken between February 1, 2012, and May 22, 2013, were identified from the database at the Norwegian Institute of Public Health and were retrospectively analyzed for a broad repertoire of drugs relevant for impairment. The prevalence of different drugs among the suspected drunk and drugged drivers was studied. Regarding drug concentrations, the findings in older drivers (>65 years) were compared to a reference group of apprehended drivers aged 20–40 years.

Results: Four hundred and ten older suspected drunk and drugged drivers were included. Any drug (including ethanol) was detected in 92% of blood samples, and ethanol was detected in 81%. Benzodiazepines were found in 15% of the older drivers and z-hypnotics (zopiclone or zolpidem) were detected in 13%. The most frequent single legal drugs found in blood samples taken from older impaired drivers were zopiclone (9.8%) and diazepam (9.3%). Regarding drug combinations, older drivers used a mean number of 1.4 drugs, and 20% of ethanol-positive cases showed at least one other drug. High drug concentrations of clonazepam and diazepam were more frequently seen in the younger group.

Conclusions: This study showed that drugs were detected in the vast majority of older drivers suspected for drunk or drugged driving. Ethanol was the most frequent drug detected, followed by zopiclone and diazepam. Older drivers combine drugs to a lesser degree than younger drivers, but their combination of ethanol and other drugs represents a considerable traffic risk. Lower concentrations of benzodiazepines are seen in older compared to younger drivers.     

Motorcycle safety among motorcycle taxi drivers and nonoccupational motorcyclists in developing countries: A case study of Maoming,South China

Objective: An increasing number of motorcycle taxis have been involved in traffic crashes in many developing countries. This study examines the characteristics of both motorcycle taxi drivers and nonoccupational motorcyclists, investigates the risks they pose to road safety, and provides recommendations to minimize their risks.

Methods: Based on the data collected from a questionnaire survey of 867 motorcycle taxi drivers and 2,029 nonoccupational motorcyclists in Maoming, South China, comparisons were made to analyze differences of personal attributes, attitudes toward road safety, and self-reported behavior of the 2 groups.

Results: Results of the chi-square tests show that not only motorcycle taxi drivers but also nonoccupational motorcyclists in Maoming held poor attitudes toward road safety and both groups reported unsafe driving behavior. There is much room for improving local road safety education among all motorcyclists in Maoming. Yet, motorcycle taxi drivers were more likely to pose road safety risks than nonoccupational motorcyclists under some circumstances, such as speeding late at night or early in the morning, not requiring passengers to wear helmets, and running a red light. The results of the binary logistic regression model show that possessing a vehicle license for a motorcycle or not was the common significant predictor for unsafe driving behavior of motorcycle taxi drivers and nonoccupational motorcyclists. Therefore, enforcement against all motorcyclists not showing vehicle licenses for their motorcycles should be stepped up.

Conclusion: Motorcycle safety is largely poor in Maoming. Therefore, efforts to improve motorcycle safety should be strengthened by targeting not only motorcycle taxi drivers but also nonoccupational motorcyclists.     

Ankle fracture patterns in drivers are associated with femoral fracture,higher BMI,and advanced age

Objective: Despite advances in vehicle safety systems, motor vehicle crashes continue to cause ankle fractures. This study attempts to provide insight into the mechanisms of injury and to identify the at-risk population groups.

Methods: A study was made of ankle fractures patients treated at an urban level 1 trauma center following motor vehicle crashes, with a concurrent analysis of a nationally representative crash data set. The national data set focused on ankle fractures in drivers involved in frontal crashes. Statistical analysis was applied to the national data set to identify factors associated with fracture risk.

Results: Malleolar fractures occurred most frequently in the driver's right foot due to pedal interaction. The majority of complex/open fractures occurred in the left foot due to interaction with the vehicle floor. These fractures occurred in association with a femoral fracture, but their broad injury pattern suggests a range of fracture causation mechanisms. The statistical analysis indicated that the risk of fracture increased with increasing driver body mass index (BMI) and age.

Conclusions: Efforts to reduce the risk of driver ankle injury should focus on right foot and pedal interaction. The range of injury patterns identified here suggest that efforts to minimize driver ankle fracture risk will likely need to consider injury tolerances for flexion, pronation/supination, and axial loading in order to capture the full range of injury mechanisms. In the clinical environment, physicians examining drivers after a frontal crash should consider those who are older or obese or who have severe femoral injury without concurrent head injury as highly suspicious for an ankle injury.     

驾驶员心理特征与驾驶安全的关系研究

随着人-车-环境系统复杂性的增加和交通事故数量的上升,新型交通工具对驾驶员的要求随之提高。从人的心理与控制的关系及汽车驾驶员的心理特征出发,具体分析心理各特征因素对驾驶员的影响,在此基础上建立汽车驾驶员安全评价模型,最后提出了在考虑心理因素的前提下提高道路行车安全的具体措施。     

Prioritization of applicable drivers for green supply chain management implementation toward sustainability in Thailand

ABSTRACT

It is essential that the green supply chain management (GSCM) implementation is effectively supported by several strategic drivers for successful implementation and sustainability, especially for the ‘green’ start-ups with a sustainability-driven organizational strategy. This study aims to determine and prioritize the applicable drivers for GSCM implementation of sustainable development strategies in the electronics industry in Thailand. The applicable drivers and their priorities are obtained by applying the fuzzy group decision-making approaches including fuzzy Delphi and fuzzy Analytic Hierarchy Process, based on Thai experts’ perspectives. In this study, three prominent organizational theories, resource-based view, relational view, and institutional theory, are needed to explain the drivers of sustainability and to develop a hierarchical model for prioritization of the drivers. Finally, based on the findings of this study, several recommendations are made that may help to improve the sustainable development in Thailand through more effective implementation of GSCM.     

Ergonomic Program Effectiveness: Ergonomic and Medical Intervention

The implementation of a successful ergonomic and medical intervention program designed to reduce the number and severity of injuries and illnesses and the associated levels of discomfort in the workplace is presented. Because of the recent activity concerning the on-again-off-again Occupational Safety and Health Administration (OSHA) Ergonomic Program Standard questions have been raised as to the value and effectiveness of an organization’s ergonomics program. In light of these concerns, the immense cost associated with work-related injury and illness, and the related pain and suffering associated with such injuries and illnesses, it is important to present a workable and effective ergonomic and medical intervention program. The results of this applied study demonstrate that through the application of an ergonomic and medical intervention program, workplace-related injuries and illnesses can be reduced or eliminated.     

Investigation of work-related musculoskeletal disorders among male kitchen workers in South India

Objective. This study aims to quantify the prevalence of work-related musculoskeletal disorders (MSDs) and risks among male kitchen workers in the catering industry. Method. Data were collected with the help of the Nordic musculoskeletal questionnaire and by direct observations. Results. In total, 114 male kitchen workers from various hostels of a college in South India were considered for this study. The average age and mean years of employment of the workers are 26.4 (SD 7.7) and 7.8 respectively. The statistical analysis carried out reveals that 67.5% of male kitchen workers reported MSDs during the past 12 months. The highest prevalence rate has been found in the lower back (65.8%) and shoulder region (62.3%). Among different categories of kitchen work analyzed, it is evident that chief cooks suffer more from MSDs (79.2%) than assistant cooks (74.3%) and kitchen aides (30.0%). Workers in the older group, i.e., ≥41 years, and workers with 6–10 years of experience suffer with higher risk of MSDs, i.e., 93.9% and 87.5%, respectively. Conclusion. The male kitchen workers who participated in this research were found to possess both MSDs and ergonomic hazards.     

Multiple dimensions of work-related risk factors and their relationship to work ability among industrial workers in Iran

Objectives. The present study was designed to investigate the simultaneous effects of physical, psychosocial and other work-related risk factors on the work ability index (WAI) score among industrial workers. Methods. This study used a cross-sectional design with a questionnaire survey. A total of 280 workers were included in the study. Data were collected using three questionnaires including the Persian version of the WAI, the Persian version of the job content questionnaire and an author-developed measure (to assess work-related factors, health-related factors and socio-demographic characteristics). Results. The majority of the participants were young, but they had poor WAI scores (mean 37.3?±?6.4) and 44.3% of them had poor or moderate work ability. Occupational accidents and injuries were found to be the strongest predictors of WAI scores. Additionally, there was a strong association between WAI scores and supervisor support, skill discretion, occupational training, sleep quality, work nature and educational level. Conclusions. Intervention programs should focus on improving supervisor support, sleep quality, job skills and knowledge and on decreasing physical and mental work demands. Additionally, implementing a comprehensive occupational health and ergonomics program for controlling and reducing hazardous working environments and occupational injury rates should be considered.