Hypoproteinemia as a prognostic risk factor for arteriovenous fistula failure

Introduction: Any vascular access is of limited duration with many factors which influence survival in patients on chronic hemodialysis (HD). Hypoproteinemia as a marker of chronic illness is common among chronic HD patients. Our aim was to analyze the survival of the primary arteriovenous fistula (AVFs) and the risk factors which influence their patency and to test the hypothesis that patients with normal values of serum proteins have lower risk of AVF failure compared to patients with hypoproteinemia. Methods: Seven hundred thirty‐four consecutive patients were included who underwent creation of an AVF. The patients were prospectively followed‐up for 2 years. Only patients with AVF function after a month from its creation were analyzed. The patients were divided into two subgroups, with normal and low serum protein levels (<65 g/L). Findings: At follow‐up 497 (67.7%) AVFs were still functional while 237 (32.3%) AVFs failed due to thrombosis or stenosis. Serum proteins and AVFs created on the forearm were positive predictors while diabetes was a negative predictor of longer AVF survival (P < 0.001; P = 0.003; P = 0.043). When comparing patients with normal and low serum protein levels (<65 g/L), mean survival time was significantly longer in patients with normal serum levels (P < 0.001). Discussion: In this study, hypoproteinemia was an independent prognostic marker for AVF failure at 2 years. Hypoproteinemia, based on our results, is an independent, more sensitive and prognostic marker of possible vascular access failure than the presence of other common factors which influence shorter AVF survival.     

Background music as a risk factor for distraction among young-novice drivers

There are countless beliefs about the power of music during driving. The last thing one would think about is: how safe is it to listen or sing to music? Unfortunately, collisions linked to music devices have been known for some time; adjusting the radio controls, swapping tape-cassettes and compact-discs, or searching through MP3 files, are all forms of distraction that can result in a near-crash or crash. While the decrement of vehicular performance can also occur from capacity interference to central attention, whether or not music listening is a contributing factor to distraction is relatively unknown. The current study explored the effects of driver-preferred music on driver behavior. 85 young-novice drivers completed six trips in an instrumented Learners Vehicle. The study found that all participants committed at-least 3 driver deficiencies; 27 needed a verbal warning/command and 17 required a steering or braking intervention to prevent an accident. While there were elevated positive moods and enjoyment for trips with driver-preferred music, this background also produced the most frequent severe driver miscalculations and inaccuracies, violations, and aggressive driving. However, trips with music structurally designed to generate moderate levels of perceptual complexity, improved driver behavior and increased driver safety. The study is the first within-subjects on-road high-dose double-exposure clinical-trial investigation of musical stimuli on driver behavior.     

Outcomes one year after a road accident: Results from the ESPARR cohort

Objective

Reducing the rates of death, trauma and sequelae associated with road accidents is the prime goal of road safety authorities, and success requires having data on victims’ outcomes in the long term. The present study examined the outcome of adult road accident victims one year after their accident.

Design

A follow-up study.

Methods

The cohort comprised 886 injured road-accident victims, aged ≥16 years, and living in the Rhône administrative Département, France (taken from the ESPARR Cohort). Data were collected on victim characteristics at the time of crash, and self-reported outcomes one year later. The population of respondents at the one-year questionnaire follow-up was divided into two categories according to injury severity, as mild-to-moderate (M.AIS < 3) or severe (M.AIS 3+). Qualitative variables were compared between these 2 groups using Chi² or Fisher exact tests.

Results

At one year post-accident, 45% of the mild-to-moderate injury group versus only 20% of severely injured subjects reported full recovery of health (p < 0.001). 20% of the cohort, as a whole, reported permanent pain. More than half of the severely injured subjects reported that the accident had had an impact on the everyday life of their family; this was twice as many as in the mild-to-moderate injury group (55% vs. 22%). Most of the severely injured reported impact on leisure, projects and emotional life: 20% reported relational difficulties in the couple, 16% reported impaired sexual life, and the rate of separation was significantly higher than in the mild-to-moderate injury group (5% vs. 1%; p < 0.001). Mean time off work was significantly longer in the severe injury group: 245 ± 158 days vs. 75 ± 104 days (p < 0.001); and 32% of the severe injury group (p < 0.001) who had stopped work had not returned at 1 year, compared to 5% of the mild-to-moderate injury group.

Conclusions

One year after a road accident, the consequences for victims remain significant. In terms of physical impact, pain frequently persists, impairing daily life for many. There is an elevated rate of chronic PTSD (post-traumatic stress disorder) and a non-negligible impact on affective and occupational life.     

Firearms in US homes as a risk factor for unintentional gunshot fatality

This study used national data and a matched case-control design to estimate the relative risk of death by an unintentional gunshot associated with having firearms in the home. A sample of adults who died in the United States in 1993 from unintentional gunshot injuries was drawn from the National Mortality Followback Survey (NMFS) (n=84). Twenty controls were sought for each case from the 1994 National Health Interview Survey (NHIS) and matched to the cases by sex, age group, race, and region of residence (n=1451). Subjects were classified as having or not having guns in the home based interview responses. The relative risk of death by an unintentional gunshot injury, comparing subjects living in homes with and without guns, was 3.7 (95% confidence interval (CI)=1.9-7.2). Adjustment for covariates resulted in little change in the effect estimates. There was evidence of a dose-response effect: compared to subjects living in homes with no guns, the relative risk was 3.4 (95% CI=1.5-7.6) among subjects with one gun and 3.9 (95% CI=2.0-7.8) among subjects with multiple guns in the home. Having handguns in the home was associated with the largest effect estimates. Tests of homogeneity showed that the effect estimates did not vary significantly across categories of the matching variables. Firearms in the home appear to be a risk factor for unintentional gunshot fatality among adults. The magnitude of the observed effect estimates should be compared with those from additional studies.     

A few seconds to have an accident,a long time to recover: Consequences for road accident victims from the ESPARR cohort 2 years after the accident

Objective

The aim of the present study was to describe the consequences of a road accident in adults, taking account of the type of road user, and to determine predictive factors for consequences at 2 years.

Design

Prospective follow-up study.

Methods

The cohort was composed of 1168 victims of road traffic accidents, aged ≥16 years. Two years after the accident, 912 victims completed a self-administered questionnaire. Weighted logistic regression models were implemented to compare casualties still reporting impact related to the accident versus those reporting no residual impact. Five outcomes were analysed: unrecovered health status, impact on occupation or studies, on familial or affective life, on leisure or sport activities and but also the financial difficulties related to the accident.

Results

46.1% of respondents were motorised four-wheel users, 29.6% motorised two-wheel (including quad) users, 13.3% pedestrians (including inline skate and push scooter users) and 11.1% cyclists. 53.3% reported unrecovered health status, 32.0% persisting impact on occupation or studies, 25.2% on familial or affective life, 46.9% on leisure or sport activities and 20.2% still had accident-related financial difficulties. Type of user, adjusted on age and gender, was linked to unrecovered health status and to impact on leisure or sport activities. When global severity (as measured by NISS) was integrated in the previous model, type of user was also associated with impact on occupation or studies. Type of user was further associated with impact on occupation or studies and on leisure or sport activities when global severity and the sociodemographic data obtained at inclusion were taken into account. It was not, however, related to any of the outcomes studied here, when the models focused on the injured body region. Finally, type of road user did not seem, on the various predictive models, to be related to financial difficulties due to the accident or to impact on familial or affective life.

Conclusions

Overall, victims were affected by their accident even 2 years after it occurred. The severity of lesions induced by the accident was the main predictive factor. However, considering lesion as intermediary factors between the accident and the recovery status at 2 year post-accident, impact on health status was lower for cyclists than M4W users or M2W users.     

Safety-critical event risk associated with cell phone tasks as measured in naturalistic driving studies: A systematic review and meta-analysis

A systematic review and meta-analysis of naturalistic driving studies involving estimates of safety-critical event risk associated with handheld device use while driving is described. Fifty-seven studies identified from targeted databases, journals and websites were reviewed in depth, and six were ultimately included. These six studies, published between 2006 and 2014, encompass seven sets of naturalistic driver data and describe original research that utilized naturalistic methods to assess the effects of distracting behaviors. Four studies involved non-commercial drivers of light vehicles and two studies involved commercial drivers of trucks and buses. Odds ratios quantifying safety-critical event (SCE) risk associated with talking, dialing, locating or answering, and texting or browsing were extracted. Stratified meta-analysis of pooled odds ratios was used to estimate SCE risk by distraction type; meta-regression was used to test for sources of heterogeneity. The results indicate that tasks that require drivers to take their eyes off the road, such as dialing, locating a phone and texting, increase SCE risk to a greater extent than tasks that do not require eyes off the road such as talking. Although talking on a handheld device did not increase SCE risk, further research is required to determine whether it indirectly influences SCE risk (e.g., by encouraging other cell phone activities). In addition, a number of study biases and quality issues of naturalistic driving studies are discussed.     

Alcohol consumption as an incremental factor in health care costs for traffic accident victims: Evidence in a medium sized Colombian city

Objectives

Identify the possibility that alcohol consumption represents an incremental factor in healthcare costs of patients involved in traffic accidents.

Methods

Data of people admitted into three major health institutions from an intermediate city in Colombia was collected. Socio-demographic characteristics, health care costs and alcohol consumption levels by breath alcohol concentration (BrAC) methodology were identified. Generalized linear models were applied to investigate whether alcohol consumption acts as an incremental factor for healthcare costs.

Results

The average cost of healthcare was 878 USD. In general, there are differences between health care costs for patients with positive blood alcohol level compared with those who had negative levels. Univariate analysis shows that the average cost of care can be 2.26 times higher (95% CI: 1.20–4.23), and after controlling for patient characteristics, alcohol consumption represents an incremental factor of almost 1.66 times (95% CI: 1.05–2.62).

Conclusions

Alcohol is identified as a possible factor associated with the increased use of direct health care resources. The estimates show the need to implement and enhance prevention programs against alcohol consumption among citizens, in order to mitigate the impact that traffic accidents have on their health status. The law enforcement to help reduce driving under the influence of alcoholic beverages could help to diminish the economic and social impacts of this problem.     

Risk of road accident associated with the use of drugs: A systematic review and meta-analysis of evidence from epidemiological studies

This paper is a corrigendum to a previously published paper where errors were detected. The errors have been corrected in this paper. The paper is otherwise identical to the previously published paper. A systematic review and meta-analysis of studies that have assessed the risk of accident associated with the use of drugs when driving is presented. The meta-analysis included 66 studies containing a total of 264 estimates of the effects on accident risk of using illicit or prescribed drugs when driving. Summary estimates of the odds ratio of accident involvement are presented for amphetamines, analgesics, anti-asthmatics, anti-depressives, anti-histamines, benzodiazepines, cannabis, cocaine, opiates, penicillin and zopiclone (a sleeping pill). For most of the drugs, small or moderate increases in accident risk associated with the use of the drugs were found. Information about whether the drugs were actually used while driving and about the doses used was often imprecise. Most studies that have evaluated the presence of a dose-response relationship between the dose of drugs taken and the effects on accident risk confirm the existence of a dose-response relationship. Use of drugs while driving tends to have a larger effect on the risk of fatal and serious injury accidents than on the risk of less serious accidents (usually property-damage-only accidents). The quality of the studies that have assessed risk varied greatly. There was a tendency for the estimated effects of drug use on accident risk to be smaller in well-controlled studies than in poorly controlled studies. Evidence of publication bias was found for some drugs. The associations found cannot be interpreted as causal relationships, principally because most studies do not control very well for potentially confounding factors.     

Explaining the road accident risk: Weather effects

This research aims to highlight the link between weather conditions and road accident risk at an aggregate level and on a monthly basis, in order to improve road safety monitoring at a national level. It is based on some case studies carried out in Work Package 7 on “Data analysis and synthesis” of the EU-FP6 project “SafetyNet – Building the European Road Safety Observatory”, which illustrate the use of weather variables for analysing changes in the number of road injury accidents. Time series analysis models with explanatory variables that measure the weather quantitatively were used and applied to aggregate datasets of injury accidents for France, the Netherlands and the Athens region, over periods of more than 20 years. The main results reveal significant correlations on a monthly basis between weather variables and the aggregate number of injury accidents, but the magnitude and even the sign of these correlations vary according to the type of road (motorways, rural roads or urban roads). Moreover, in the case of the interurban network in France, it appears that the rainfall effect is mainly direct on motorways – exposure being unchanged, and partly indirect on main roads – as a result of changes in exposure. Additional results obtained on a daily basis for the Athens region indicate that capturing the within-the-month variability of the weather variables and including it in a monthly model highlights the effects of extreme weather. Such findings are consistent with previous results obtained for France using a similar approach, with the exception of the negative correlation between precipitation and the number of injury accidents found for the Athens region, which is further investigated. The outlook for the approach and its added value are discussed in the conclusion.     

The analysis of accident precursors and near misses: Implications for risk assessment and risk management

This paper presents an analysis of accident precursors or ‘near misses’ (e.g. the space shuttle flights with damaged O-rings prior to the Challenger disaster). The interpretation of such events is often problematic, since the ambiguous nature of the evidence in such cases makes them subject to widely divergent interpretations. Simple Bayesian analysis provides a resolution of this problem, showing that an accident precursor almost always justifies increased rather than decreased estimates of overall accident frequencies.     

Driving with pets as a risk factor for motor vehicle collisions among older drivers

Increasing rates of distraction-related motor vehicle collisions (MVCs) continue to raise concerns regarding driving safety. This study sought to evaluate a novel driving-related distraction, driving with a pet, as a risk factor for MVCs among older, community dwelling adults. Two thousand licensed drivers aged 70 and older were identified, of whom 691 reported pet ownership. Comparing pet owners who did and did not drive with their pets, neither overall MVC rates (rate ratio [RR] 0.97, 95% confidence interval [CI] 0.75–1.26) nor at-fault MVC rates (RR 0.84, 95% CI 0.57–1.24) were elevated. However, those who reported always driving with a pet in the vehicle had an elevated MVC rate (RR 1.89, 95% CI 1.10–3.25), as compared to those who did not drive with a pet. The MVC rate was not increased for those reporting only sometimes or rarely driving with a pet in the vehicle. The current study demonstrates an increased risk of MVC involvement in those older drivers who always take a pet with them when they drive a vehicle. When confronted with an increased cognitive or physical workload while driving, elderly drivers in prior studies have exhibited slower cognitive performance and delayed response times in comparison to younger age groups. Further study of pet-related distracted driving behaviors among older drivers as well as younger populations with respect to driver safety and performance is warranted to appropriately inform the need for policy regulation on this issue.     

NaCl as a retrospective and accident dosemeter

NaCl is a cheap and widely available material. This study investigated the potential of NaCl in the form of a household salt as a retrospective and accident dosemeter using optically stimulated luminescence (OSL). Samples of the investigated household salt were stimulated using blue light of linearly modulated power. Attention was concentrated on sensitivity, dose dependence of the OSL signal, fading, optimisation of the read-out procedure and application of analytical protocols that do not require a specific calibration. A potential of NaCl as a complementary dosemeter within emergency preparedness was considered. The behaviour of the OSL signal observed was found to be favourable for dosimetry.     

Formulating accident occurrence as a survival process

A conceptual framework for accident occurrence is developed based on the principle of the driver as an information processor. The framework underlies the development of a modeling approach that is consistent with the definition of exposure to risk as a repeated trial. Survival theory is proposed as a statistical technique that is consistent with the conceptual structure and allows the exploration of a wide range of factors that contribute to highway operating risk. This survival model of accident occurrence is developed at a disaggregate level, allowing safety researchers to broaden the scope of studies which may be limited by the use of traditional aggregate approaches. An application of the approach to motor carrier safety is discussed as are potential applications to a variety of transportation industries. Lastly, a typology of highway safety research methodologies is developed to compare the properties of four safety methodologies: laboratory experiments, on-the-road studies, multidisciplinary accident investigations, and correlational studies. The survival theory formulation has a mathematical structure that is compatible with each safety methodology, so it may facilitate the integration of findings across methodologies.     

Multiday driving patterns and motor carrier accident risk: a disaggregate analysis.

A method has been developed to estimate the relative accident risk posed by different patterns of driving over a multiday period. The procedure explicitly considers whether a driver is on duty or off duty for each half hour of each day during the period of analysis. From a data set of over 1,000 drivers, nine distinct driving patterns are identified. Membership in the patterns is determined exclusively by the pattern of duty hours for seven consecutive days; for some drivers an accident occurred on the eighth day while others had no accident, therefore each pattern can be associated with a relative accident risk. Additional statistical modeling allowed the consideration, in addition to driving pattern, of driver age, experience with the firm, hours off duty prior to the last trip and hours driving on the last trip (either until the accident or successful completion of the trip). The finding of the modeling is that driving patterns over the previous seven days significantly affect accident risk on the eighth day. In general, driving during the early and late morning (e.g., midnight to 10 A.M.) has the highest accident risk while all seven other multiday patterns had indistinguishable risk. Consecutive hours driven also has a significant effect on accident risk: the first hour through the fourth hour having the lowest risk with a fluctuating increase in risk to a maximum beyond nine hours. Driver age and hours off duty immediately prior to a trip do not appear to affect accident risk significantly. These findings quantitatively assess the relative accident risk of multiday driving patterns using data from actual truck operations. Further research is recommended in the areas of refining model structures, adding explanatory variables (such as highway type), and testing more complex models.     

Measuring accident risk exposure for pedestrians in different micro-environments

Pedestrians are mainly exposed to the risk of road accident when crossing a road in urban areas. Traditionally in the road safety field, the risk of accident for pedestrian is estimated as a rate of accident involvement per unit of time spent on the road network. The objective of this research is to develop an approach of accident risk based on the concept of risk exposure used in environmental epidemiology, such as in the case of exposure to pollutants. This type of indicator would be useful for comparing the effects of urban transportation policy scenarios on pedestrian safety. The first step is to create an indicator of pedestrians’ exposure, which is based on motorised vehicles’ “concentration” by lane and also takes account of traffic speed and time spent to cross. This is applied to two specific micro-environments: junctions and mid-block locations. A model of pedestrians’ crossing behaviour along a trip is then developed, based on a hierarchical choice between junctions and mid-block locations and taking account of origin and destination, traffic characteristics and pedestrian facilities. Finally, a complete framework is produced for modelling pedestrians’ exposure in the light of their crossing behaviour. The feasibility of this approach is demonstrated on an artificial network and a first set of results is obtained from the validation of the models in observational studies.