Characterization of drug and alcohol use among senior drivers fatally injured in U.S. motor vehicle collisions, 2008–2012

Objective: Adults 65 years of age and older comprise the fastest growing demographic in the United States. As substance use is projected to increase in this population, there is concern that more seniors will drive under the influence of impairing drugs. The purpose of this analysis was to characterize the drug and alcohol usage among senior drivers fatally injured (FI) in traffic collisions.

Methods: Data from the Fatality Analysis Reporting System were analyzed from 2008 to 2012. Commonly used classes and specific drugs were explored. Rates of drug use, multiple drugs, concomitant drug and alcohol use, and alcohol use alone were generated using Poisson regression with robust error variance estimation. Rates were compared to a reference population of FI middle-aged drivers (30 to 50 years old) using rate ratios.

Results: Drug use among FI senior drivers occurred in 20.0% of those tested. Among drug-positive FI senior drivers, narcotics and depressants were frequent. The prevalence of testing positive for any drug, multiple drugs, combined drug and alcohol, and alcohol use alone among FI seniors were 47% less (relative risk [RR] = 0.53, 95% confidence interval [CI], 0.47, 0.62), 59% less (RR = 0.41, 95% CI, 0.34, 0.51), 87% less (RR = 0.13, 95% CI, 0.09, 0.19), and 77% less (RR = 0.23, 95% CI, 0.19, 0.28), respectively, compared to FI middle-aged drivers.

Conclusions: Though overall drug use is less common among FI senior drivers relative to FI middle-aged drivers, driving under the influence of drugs may be a relevant traffic safety concern in a portion of this population.     

杭州高速公路交通事故流行病学特点分析

目的:研究杭州高速公路交通事故的流行病学特点。方法:收集了2003—2006年杭州高速公路交通事故资料并对其进行流行病学分析。结果:①2003—2006年期间,发生交通事故8906起,涉及车辆12692辆,死亡115人,受伤1976人,造成直接经济损失1.15亿元;②交通事故以10月和1月发生最多,每周事故数呈逐渐上升趋势,9:00—11:00点和14:00—16:00点为事故的高发时段;③因驾驶员造成的交通事故超过事故总数的90%,主要原因为未保持安全的纵向距离和操作不当;车辆原因主要为爆胎和制动问题、天气及照明对事故有一定影响;④在高速公路交通事故中,乘客与驾驶员受到的危害程度相同。结论:研究高速公路交通事故的流行病学特点将有利于采取科学的措施减小高速公路交通事故给社会带来的危害。     

Per- and polyfluoroalkyl substances and obesity,type 2 diabetes and non-alcoholic fatty liver disease: a review of epidemiologic findings

Abstract

Per- and polyfluoroalkyl substances, a group of fluoro-surfactants widely detected in the environment, wildlife, and humans, have been linked to adverse health effects. A growing body of literature has addressed their effects on obesity, diabetes and non-alcoholic fatty liver disease/non-alcoholic steatohepatitis. This review summarizes the brief historical use and chemistry of per- and polyfluoroalkyl substances, routes of human exposure, as well as the epidemiologic evidence for associations between exposure to per- and polyfluoroalkyl substances and the development of obesity, diabetes and non-alcoholic fatty liver disease/non-alcoholic steatohepatitis. We identified 22 studies on obesity and 32 studies on diabetes, while only 1 study was found for non-alcoholic fatty liver disease/non-alcoholic steatohepatitis by searching PubMed for human studies. Approximately two-third of studies reported positive associations between per- and polyfluoroalkyl substances exposure and the prevalence of obesity and/or type 2 diabetes. Causal links between per- and polyfluoroalkyl substances and obesity, diabetes and non-alcoholic fatty liver disease/non-alcoholic steatohepatitis, however, require further large-scale prospective cohort studies combined with mechanistic laboratory studies to better assess these associations.     

The association between total urinary arsenic concentration and renal dysfunction in a community-based population from central Taiwan

Arsenic (As) is an important environmental toxicant that can cause cancer and cardiovascular disease, but the relationship between As exposure and renal dysfunction is not clear. The aim of this study is to examine the association between As exposure and renal dysfunction in a community-based population in central Taiwan. One thousand and forty-three subjects were recruited between 2002 and 2005. The risk for type 2 diabetes was increased by 2-fold (p < 0.05) in subjects with total urinary As (U-As) > 75 μg g⁻¹ creatinine as compared with subjects whose U-As was ?35 μg g⁻¹ creatinine after the adjustment for potential confounders. The adjusted odds ratio for an abnormal β2 microglobulin (B2MG > 0.154 mg L⁻¹) was significantly higher in subjects with U-As > 35 μg g⁻¹ creatinine as compared with the reference group adjusted for age, sex, living area, cigarette smoking, diabetes, and hypertension. The risk for abnormal B2MG and estimated glomerular filtration rate (eGFR < 90 mL min⁻¹ (1.73 m²)⁻¹) was both increased around 2-fold (p < 0.05) in subjects with U-As > 75 μg g⁻¹ creatinine as compared with those with U-As ? 35 μg g⁻¹ creatinine adjusted for all the risk factors plus lead (Pb), cadmium and nickel. The prevalence of abnormal B2MG was 4.82 times higher in subjects with both over the median levels of U-As (85.1 μg L⁻¹) and urinary Pb (18.9 μg L⁻¹) as compared to both lower than the median (p < 0.001). These results indicate that U-As might relate to renal dysfunction even other important risk factors were taken into account. Follow-up studies for causal inference are warranted.     

Imputing Unmeasured Explanatory Variables in Environmental Epidemiology With Application to Health Impact Analysis of Air Pollution

This paper presents the results of a reconsideration of earlier work that finds an association between daily hospital admissions for respiratory distress and daily concentrations of sulphate (lag 1) as well as daily maximum concentrations of ozone (lags 1 and 3). These associations are found even after clustering the data by hospital of admission and accounting for the effects of temperature. We use an adaptation of their generalized estimating equation technique for clustered data, that daily data being for southern Ontario summers from 1983 to 1988. Like them, we adjust for daily maximum temperatures. However, unlike the earlier work returned to ours includes daily average humidity as a potential explanatory variable in our model. Our analysis also differs from theirs in that we cluster the data by census subdivision to reduce the risk of confounding pollutant levels with population size within regions. Moreover, we log-transform the explanatory variables and then high-pass filter the resulting data. We also deviate from the earlier analysis by taking account of measurement error incurred in using surrogate measures of the explanatory variables. To do so we use new methodology designed for our study but of potential value in other applications. That methodology requires a spatial predictive distribution for the unmeasured explanatory variables. Each day about 700 missing measurements for each of these variables can then be imputed over the geographical domain of the study. With these imputations we get a measure of imputation error through the covariance of the predictive distribution. Along with the predictive distribution we require an impact model to link-up with the predictive distribution. We describe that model and show how it uses the imputed measurements of the missing values of the explanatory variables. We also show how through that model, uncertainty about these values is reflected in our analysis and in commensurate uncertainties in the inferences made. Apart from its substantive objectives, our analysis serves to test the new methods with the earlier results serving as a foil. The reassuring qualitative agreement between our findings and the earlier results seems encouraging.     

大气颗粒物暴露与健康效应研究进展

大气颗粒物一直是影响我国大多数城市空气质量的首要污染物,且呈现出与欧美不同的煤烟、机动车尾气以及开放源复合型污染并存的高浓度污染态势,已有研究发现颗粒物的短期或长期暴露均会对人体产生不良的健康效应。本文从环境科学、暴露科学、环境流行病学和环境毒理学研究等方面系统综述了大气颗粒物健康效应研究的方法和进展,可为我国的大气颗粒物健康效应研究与大气颗粒物环境质量标准的修订提供方法学参考和经验借鉴。目前我国PM10污染尚未得到有效控制,细颗粒物(PM2.5)的污染也已引起关注,建议在不同区域开展空气污染健康效应的系统研究。     

Quantifying the burden of managing wildlife diseases in multiple host species

Mitigation of infectious wildlife diseases is especially challenging where pathogens affect communities of multiple host species. Although most ecological studies recognize the challenge posed by multiple-species pathogens, the implications for management are typically assessed only qualitatively. Translating the intuitive understanding that multiple host species are important into practice requires a quantitative assessment of whether and how secondary host species should also be targeted by management and the effort this will require. Using a multiple-species compartmental model, we determined analytically whether and how intensively secondary host species should be managed to prevent outbreaks in focal hosts based on the reproduction number of individual host species and between-species transmission rates. We applied the model to the invasive pathogenic fungus Batrachochytrium salamandrivorans in a 2-host system in northern Europe. Avoiding a disease outbreak in the focal host (fire salamanders [Salamandra salamandra]) was impossible unless management also heavily targeted the secondary host (alpine newts [Ichthyosaura alpestris]). Preventing an outbreak in the community required targeted removal of at least 80% of each species. This proportion increased to 90% in the presence of an environmental reservoir of B. salamandrivorans and when the proportion of individuals removed could not be adjusted for different host species (e.g., when using traps that are not species specific). We recommend the focus of disease-mitigation plans should shift from focal species to the community level and calculate explicitly the management efforts required on secondary host species to move beyond the simple intuitive understanding that multiple host species may all influence the system. Failure to do so may lead to underestimating the magnitude of the effort required and ultimately to suboptimal or futile management attempts.     

Impact of drought‐related vaccination on livestock mortality in pastoralist areas of Ethiopia

Under a national Livestock Policy Forum in Ethiopia the impact of livestock vaccination during drought was assessed in order to inform the development of a best‐practice guideline. For each of the different types of vaccine used during drought years there was no significant difference in livestock mortality, for any species, in vaccinated compared with non‐vaccinated herds. The limited impact of vaccination on livestock mortality was attributed to weaknesses in the design and implementation of vaccination programmes, including use of inappropriate vaccines, low vaccination coverage, problems with vaccine dosing, incorrect timing of vaccination and problems with vaccine storage. If these weaknesses could be overcome vaccination could be a useful means to protect livestock assets, with considerable benefit‐cost ratios. Vaccination should be conducted as a standard preventive measure during normal years, and programme design should be informed by participatory epidemiological studies.     

Correlating element atmospheric deposition and cancer mortality in Portugal: data handling and preliminary results

This study, framed within geographical epidemiology, presents preliminary findings concerning the association between the concentrations of chemical elements obtained through atmospheric biomonitoring with lichens and cancer mortality in the Portuguese population. Exploratory analyses were performed to identify potential confounders for the relationships between chemical elements and neoplasm mortality and to assess the extent of their interference. The results of this study highlight some methodological and conceptual difficulties inherent to observational and geographical studies, in the specific context of the Portuguese population, and the challenge posed by the large numbers of pollutants considered.