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DiGuiseppi CG, Johnson RL, Betz ME, Hill LL, Eby DW, Jones VC, Mielenz TJ, Molnar LJ, Strogatz D, Li G. Migraine headaches are associated with motor vehicle crashes and driving habits among older drivers: Prospective cohort study. J Am Geriatr Soc 2024; 72:791-801. [PMID: 38133994 PMCID: PMC11045178 DOI: 10.1111/jgs.18719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/14/2023] [Accepted: 11/25/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Migraine headache is common in older adults, often causing symptoms that may affect driving safety. This study examined associations of migraine with motor vehicle crashes (MVCs) and driving habits in older drivers and assessed modification of associations by medication use. METHODS In a multi-site, prospective cohort study of active drivers aged 65-79 (53% female), we assessed prevalent migraine (i.e., ever had migraine, reported at enrollment), incident migraine (diagnosis first reported at a follow-up visit), and medications typically used for migraine prophylaxis and treatment. During 2-year follow-up, we recorded self-reported MVCs and measured driving habits using in-vehicle GPS devices. Associations of prevalent migraine with driving outcomes were estimated in multivariable mixed models. Using a matched design, associations of incident migraine with MVCs in the subsequent year were estimated with conditional logistic regression. Interactions between migraine and medications were tested in all models. RESULTS Of 2589 drivers, 324 (12.5%) reported prevalent migraine and 34 (1.3%) incident migraine. Interactions between migraine and medications were not statistically significant in any models. Prevalent migraine was not associated with MVCs in the subsequent 2 years (adjusted OR [aOR] = 0.98; 95% CI: 0.72, 1.35), whereas incident migraine significantly increased the odds of having an MVC within 1 year (aOR = 3.27; 1.21, 8.82). Prevalent migraine was associated with small reductions in driving days and trips per month and increases in hard braking events in adjusted models. CONCLUSION Our results suggest substantially increased likelihood of MVCs in the year after newly diagnosed migraine, indicating a potential need for driving safety interventions in these patients. We found little evidence for MVC risk or substantial changes in driving habits associated with prevalent migraine. Future research should examine timing, frequency, and severity of migraine diagnosis and symptoms, and use of medications specifically prescribed for migraine, in relation to driving outcomes.
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Affiliation(s)
- Carolyn G DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Rachel L Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado, USA
| | - Linda L Hill
- School of Public Health, University of California San Diego, La Jolla, California, USA
| | - David W Eby
- University of Michigan Transportation Research Institute, Ann Arbor, Michigan, USA
| | - Vanya C Jones
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Thelma J Mielenz
- Center for Injury Science and Prevention, Columbia University Irving Medical Center, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Lisa J Molnar
- University of Michigan Transportation Research Institute, Ann Arbor, Michigan, USA
| | | | - Guohua Li
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
- Department of Anesthesiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
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Leon SJ, Trachtenberg A, Briscoe D, Ahmed M, Hougen I, Askin N, Whitlock R, Ferguson T, Tangri N, Rigatto C, Komenda P. Opioids and the Risk of Motor Vehicle Collision: A Systematic Review. J Pharm Technol 2022; 38:54-62. [PMID: 35141728 PMCID: PMC8820048 DOI: 10.1177/87551225211059926] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
Background: Opioid analgesics are among the most commonly prescribed medications, but questions remain regarding their impact on the day-to-day functioning of patients including driving. We set out to perform a systematic review on the risk of motor vehicle collision (MVC) associated with prescription opioid exposure. Method: We searched Medline, PubMed, EMBASE, Scopus, and TRID from January 1990 to August 31, 2021 for primary studies assessing prescribed opioid use and MVCs. Results: We identified 14 observational studies that met inclusion criteria. Among those, 8 studies found an increased risk of MVC among those participants who had a concomitant opioid prescription at the time of the MVC and 3 found no significant increase of culpability of fatal MVC. The 3 studies that evaluated the presence of a dose-response relationship between the dose of opioids taken and the effects on MVC risk reported the existence of a dose-response relationship. Due to the heterogeneity of the different studies, a quantitative meta-analysis to sum evidence was deemed unfeasible. Our review supports increasing evidence on the association between motor vehicle collisions and prescribed opioids. This research would guide policies regarding driving legislation worldwide. Conclusion: Our review indicates that opioid prescriptions are likely associated with an increased risk of MVCs. Further studies are warranted to strengthen this finding, and investigate additional factors such as individual opioid medications, opioid doses and dose adjustments, and opioid tolerance for their effect on MVC risk.
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Affiliation(s)
- Silvia J. Leon
- Department of Community Health
Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB,
Canada
- Chronic Disease Innovation Centre,
Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Aaron Trachtenberg
- Department of Community Health
Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB,
Canada
| | - Derek Briscoe
- Max Rady College of Medicine,
University of Manitoba, Winnipeg, MB, Canada
| | | | - Ingrid Hougen
- Department of Community Health
Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB,
Canada
- Max Rady College of Medicine,
University of Manitoba, Winnipeg, MB, Canada
| | - Nicole Askin
- Neil John Mclean Library, University of
Manitoba, Winnipeg, MB, Canada
| | - Reid Whitlock
- Department of Community Health
Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB,
Canada
- Chronic Disease Innovation Centre,
Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Thomas Ferguson
- Department of Community Health
Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB,
Canada
- Chronic Disease Innovation Centre,
Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Navdeep Tangri
- Department of Community Health
Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB,
Canada
- Chronic Disease Innovation Centre,
Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Claudio Rigatto
- Department of Community Health
Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB,
Canada
- Chronic Disease Innovation Centre,
Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Paul Komenda
- Department of Community Health
Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB,
Canada
- Chronic Disease Innovation Centre,
Seven Oaks General Hospital, Winnipeg, MB, Canada
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Skyving M, Forsman Å, Dukic Willstrand T, Laflamme L, Möller J. Medical impairment and road traffic crashes among older drivers in Sweden - A national, population-based, case-control study. ACCIDENT; ANALYSIS AND PREVENTION 2021; 163:106434. [PMID: 34700248 DOI: 10.1016/j.aap.2021.106434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 09/23/2021] [Accepted: 10/05/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Several medical conditions are known to impair sensory, cognitive and motor functions and are associated with road traffic crashes (RTC). For the drivers of today, we lack updated knowledge on how driving-impairing conditions are associated with RTCs, across all driving-impairing conditions in a given population. We aim to determine this among older drivers in Sweden. METHODS A national, population register-based, matched case-control study comparing acknowledged driving-impairing health conditions among all older drivers (65 years or older) involved in an injurious RTC in the period 2011-2016 (n = 13,701) with those of controls: older drivers not involved in any RTC (n = 26,525) matched to the cases by age, sex and residential area. The medical conditions, extracted from the National Patient Register from 1997 up until date of RTC, were identified based on ICD-10 diagnosis codes and categorized into the 13 groups of medical conditions listed in the Swedish driver's license regulations. Conditional logistic regression was used to estimate crude and adjusted odds ratios (ORs) with 95% confidence intervals. RESULTS Unadjusted ORs for RTC were increased for all conditions. After taking the other 12 medical conditions into account, the ORs remained significant in 11 out of the 13. A strong association was found for the group "ADHD and autism spectrum disorders" (OR 2.79, CI 1.47-5.30), although with very low prevalence among cases (0.2%). Moderate associations were found for three conditions with a case prevalence between 1.3% and 8.5%: epilepsy and seizure disorders (OR 1.53, CI 1.25-1.89), substance abuse and dependence (OR 1.45, CI 1.29-1.63), psychological diseases and mental disorders (OR 1.28, CI 1.18-1.39) and for one condition with a case prevalence of 14.7%, diabetes (OR 1.28, CI 1.20-1.36). CONCLUSIONS In Sweden, in the current generation of older drivers, acknowledged driving-impairing medical conditions at the national and European levels remain a concern. After adjustment for one another, all but 2 of the conditions are associated with RTCs albeit to varying degrees and more pronounced in the age group 65-79 compared to 80 or older. To promote and sustain older people's mobility, addressing this issue will require a blend of interventions where, hopefully, technological and infrastructural innovations may help counteracting individual health-related shortcomings.
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Affiliation(s)
- Marie Skyving
- Karolinska Institutet, Department of Global Public Health, Solnavägen 1E, SE-11365 Stockholm, Sweden; Swedish Transport Agency, Department of Road and Rail, Isafjordsgatan 1, SE-16440 Kista, Sweden.
| | - Åsa Forsman
- The Swedish National Road and Transport Research Institute (VTI), Olaus Magnus väg 37, SE-58195 Linköping, Sweden.
| | | | - Lucie Laflamme
- Karolinska Institutet, Department of Global Public Health, Tomtebodavägen 18 A, SE-17165 Stockholm, Sweden.
| | - Jette Möller
- Karolinska Institutet, Department of Global Public Health, Solnavägen 1E, SE-11365 Stockholm, Sweden.
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Tepper SJ, Silberstein SD, Rosen NL, Lipton RB, Dennehy EB, Dowsett SA, Doty E. The Influence of Migraine on Driving: Current Understanding, Future Directions, and Potential Implications of Findings. Headache 2020; 60:178-189. [PMID: 31792964 PMCID: PMC7004171 DOI: 10.1111/head.13716] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To review the published findings relevant to migraine and driving performance, with an intent to encourage discussion on research which may broaden understanding in this area and help educate healthcare providers and their patients. BACKGROUND Motor vehicle crashes result in more than 35,000 deaths and more than 2 million injuries annually in the United States. Migraine is one of the most prevalent diseases in the world, and many symptoms associated with migraine attacks have the potential to negatively influence driving ability. METHODS We reviewed the published findings related to migraine and driving performance. Study findings relevant to symptoms of migraine and their potential effect on driving were also reviewed. This required a more expansive exploration of the literature beyond migraine, for example, review of the literature relating to the effect of pain, sleepiness, visual disturbances, or vertigo on driving. Finally, the potential effects of treatment for migraine on driving were reviewed. RESULTS Literature on the effect of migraine on driving performance is sparse and, in general published studies on the topic have a number of limitations. Based on review of the literature pertaining to other disorders, it seems feasible that some symptoms occurring as part of the migraine attack could impact driving performance, although formal study in this area is lacking. Many of the approved treatments for migraine have the potential to impact driving, yet this has not been specifically studied, and the extent to which these risks are communicated to patients is not clear. CONCLUSION The impact of migraine on driving performance has been largely neglected, with few studies specifically designed to address the topic, and relevant studies were generally small with limited control of confounders. This area requires more focus, given a potential for impact on road safety.
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Affiliation(s)
| | | | - Noah L. Rosen
- Northwell Health Physician Partners Neuroscience InstituteGreat NeckNYUSA
| | - Richard B. Lipton
- Montefiore Headache CenterAlbert Einstein School of MedicineThe BronxNYUSA
| | - Ellen B. Dennehy
- Eli Lilly and CompanyIndianapolisINUSA
- Department of Psychological SciencesPurdue UniversityWest LafayetteINUSA
| | | | - Erin Doty
- Eli Lilly and CompanyIndianapolisINUSA
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Ma S, Zhang J, Zeng X, Wu C, Zhao G, Lv C, Sun X. Type 2 diabetes can undermine driving performance of middle-aged male drivers through its deterioration of perceptual and cognitive functions. ACCIDENT; ANALYSIS AND PREVENTION 2020; 134:105334. [PMID: 31689573 DOI: 10.1016/j.aap.2019.105334] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/03/2019] [Accepted: 10/15/2019] [Indexed: 05/12/2023]
Abstract
It has been widely agreed that it is risky for patients with diabetes to drive during hypoglycemia. However, driving during non-hypoglycemia may also bring certain safety hazards for some patients with diabetes. Based on previous studies on diabetes-related to early aging effect, as well as gender differences in health belief and driving behavior, we have hypothesized that middle-aged male drivers with type 2 diabetes, compared with the control healthy ones, may experience a decline in driving performance without awareness. And the decline is caused by impaired perceptual and cognitive driving-related functions. To verify these hypotheses, we recruited 56 non-professional male drivers aged between 40 and 60 (27 patients with type 2 diabetes and 29 healthy controls) to perform a simulated car-following task and finish behavioral tests of proprioception, visual search, and working memory abilities during non-hypoglycemia. They also reported their hypoglycemia experience and perceived driving skills. We found that the patients had equal confidence in their driving skills but worse driving performance as shown in larger centerline deviation (t = 2.83, p = .006), longer brake reaction time (t = 3.77, p = .001) and shorter minimum time-to-collision (t = -3.27, p = .002). Such between-group differences in driving performance could be fully mediated by proprioception, visual search ability, and working memory capacity but not by hypoglycemia experience. Regarding the effect sizes of the mediation, the visual search ability played the most important role, and then followed the working memory and the proprioception. This initial study provides original and first-hand evidence demonstrating that the middle-aged male drivers with type 2 diabetes have deteriorated driving performance, but they are unaware of it. We will also discuss the possible measures to identify people of the highest risk and improve their safety awareness by using the findings of the current study.
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Affiliation(s)
- Shu Ma
- Department of Psychology, Zhejiang Sci-Tech University, 928 2nd Street, Xiasha Higher Education Park, Hangzhou, 310016, China; CAS Key Laboratory of Behavioral Science, Institute of Psychology, 16 Lincui Road, Chaoyang District, Beijing, CN 100101, China; Department of Psychology, University of the Chinese Academy of Sciences, 19 Yuquan Road, Shijingshan District, Beijing, CN 100049, China
| | - Jingyu Zhang
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, 16 Lincui Road, Chaoyang District, Beijing, CN 100101, China; Department of Psychology, University of the Chinese Academy of Sciences, 19 Yuquan Road, Shijingshan District, Beijing, CN 100049, China.
| | - Xianzhong Zeng
- Department of Endocrinology, Ganzhou People's Hospital, China
| | - Changxu Wu
- Department of Systems and Industrial Engineering, University of Arizona, United States
| | - Guozhen Zhao
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, 16 Lincui Road, Chaoyang District, Beijing, CN 100101, China; Department of Psychology, University of the Chinese Academy of Sciences, 19 Yuquan Road, Shijingshan District, Beijing, CN 100049, China
| | - Chunhui Lv
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, 16 Lincui Road, Chaoyang District, Beijing, CN 100101, China; Department of Psychology, University of the Chinese Academy of Sciences, 19 Yuquan Road, Shijingshan District, Beijing, CN 100049, China
| | - Xianghong Sun
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, 16 Lincui Road, Chaoyang District, Beijing, CN 100101, China; Department of Psychology, University of the Chinese Academy of Sciences, 19 Yuquan Road, Shijingshan District, Beijing, CN 100049, China
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6
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Miyata A, Iwamoto K, Kawano N, Aleksic B, Ando M, Ebe K, Fujita K, Yokoyama M, Akiyama T, Igarashi Y, Ozaki N. Driving performance of stable outpatients with depression undergoing real-world treatment. Psychiatry Clin Neurosci 2018; 72:399-408. [PMID: 29485228 DOI: 10.1111/pcn.12648] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/08/2017] [Accepted: 02/20/2018] [Indexed: 11/30/2022]
Abstract
AIM Although the effects of psychotropics on driving ability have received much attention, little research is available on driving performance of stable outpatients with depression undergoing real-world treatment. This observational study investigated driving performance, cognitive functions, and depressive symptomatology of partly remitted outpatients with depression under daily-practice psychopharmacologic treatment. METHODS Seventy stable outpatients with depression and 67 healthy volunteers were enrolled. Patients' prescriptions were not controlled in order to capture the real-world treatment environment. Participants underwent three driving tasks - road-tracking, car-following, and harsh-braking - using a driving simulator, and three cognitive tasks - Continuous Performance Test, Wisconsin Card Sorting Test, and Trail-Making Test. The Symptom Assessment Scale - Structured Interview Guide for the Hamilton Depression Rating Scale, Beck Depression Inventory-II, Social Adaptation Self-Evaluation Scale, and Stanford Sleepiness Scale were also completed. RESULTS Although many patients received various pharmacologic treatments, there were no significant differences in the three driving tasks between outpatients with depression and healthy controls. Difficulty of maintaining set in the Wisconsin Card Sorting Test was significantly increased in patients with depression. Results on the Social Adaptation Self-Evaluation Scale were significantly associated with road-tracking and car-following performance, in contrast to results on the Hamilton Depression Rating Scale and the Beck Depression Inventory-II. CONCLUSION We conclude that partly remitted depressive patients under steady-state pharmacologic treatment do not differ from healthy controls with respect to driving performance, which seems to be more affected by psychosocial functioning than by pharmacologic agents. This, however, should be investigated systematically in an off/on study.
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Affiliation(s)
- Akemi Miyata
- Department of Psychiatry, Nagoya University, Graduate School of Medicine, Nagoya, Japan
| | - Kunihiro Iwamoto
- Department of Psychiatry, Nagoya University, Graduate School of Medicine, Nagoya, Japan
| | - Naoko Kawano
- Department of Psychiatry, Nagoya University, Graduate School of Medicine, Nagoya, Japan.,Institutes of Innovation for Future Society, Nagoya University, Nagoya, Japan
| | - Branko Aleksic
- Department of Psychiatry, Nagoya University, Graduate School of Medicine, Nagoya, Japan
| | - Masahiko Ando
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Kazutoshi Ebe
- Toyota Central R&D Labs, Inc., Nagakute, Japan.,Collaborative Safety Research Center, Toyota Motor Engineering and Manufacturing North America, Inc., Ann Arbor, USA
| | - Kiyoshi Fujita
- Department of Psychiatry, Okehazama Hospital, Toyoake, Japan
| | | | - Tsuyoshi Akiyama
- Department of Psychiatry, NTT Medical Center Tokyo, Tokyo, Japan
| | | | - Norio Ozaki
- Department of Psychiatry, Nagoya University, Graduate School of Medicine, Nagoya, Japan
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7
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Chen VCH, Yang YH, Lee CP, Wong J, Ponton L, Lee Y, McIntyre RS, Huang KY, Wu SI. Risks of road injuries in patients with bipolar disorder and associations with drug treatments: A population-based matched cohort study. J Affect Disord 2018; 226:124-131. [PMID: 28972929 DOI: 10.1016/j.jad.2017.09.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 07/05/2017] [Accepted: 09/21/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Using a nation-wide, population-based dataset, we aimed to investigate the risk of road injury among individuals with bipolar disorder (BD) compared to individuals without BD. In addition, we investigated the putative moderating effects of prescription for lithium, anticonvulsants, antidepressants, and/or first- or second-generation antipsychotic agents on the association between BD and risk of road injury. METHOD As part of an16-year longitudinal cohort study, we compared the risk of road injuries among study subjects aged 16 and above with a diagnosis of BD, with ten age- and sex-matched sample of individuals without BD. Individuals were compared on measures of incidence on road injuries using medical claims data based on the ICD-9-CM codes: E800~807, E810~817, E819~830, E840~848. Time dependent Cox regression models were used to adjust for time-varying covariates such as age, and medication uses. Hazard ratios before and after adjusting for age, sex, other comorbidities, and drug use were calculated. RESULTS 3953 people with BD were matched with 39,530 controls from general population. Adjusted hazard ratios revealed a 1.66-fold (95% CI 1.40-1.97) increase in risk of road injuries among bipolar subjects when compared to controls. Female gender, older age (i.e. over 80), residence in areas of highest levels of urbanization, and use of antidepressants were associated with a lower risk of road injuries. CONCLUSIONS In this large, national, population-based cohort, BD was associated with an elevated risk of road injuries. However, prescriptions of antidepressants might help mitigate the foregoing risk.
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Affiliation(s)
- Vincent Chin-Hung Chen
- Department of Psychiatry, Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital at Chiayi, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yao-Hsu Yang
- School of Medicine, Chang Gung University, Taoyuan, Taiwan; Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan; Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, College of Public Health, Taipei, Taiwan
| | - Chuan-Pin Lee
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | | | - Lynn Ponton
- University of California, San Francisco (UCSF), USA
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Canada
| | - Kuo-You Huang
- Department of Speech, Language Pathology and Audiology, Chung Shan Medical University, Taiwan
| | - Shu-I Wu
- Department of Medicine, Mackay Medical College, Taipei, Taiwan; Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan; Department of Audiology, Speech, and Language Pathology, Mackay Medical College, Taipei, Taiwan.
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8
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Pharmacists' perceptions and communication of risk for alertness impairing medications. Res Social Adm Pharm 2018; 14:31-45. [DOI: 10.1016/j.sapharm.2016.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 11/19/2016] [Accepted: 12/16/2016] [Indexed: 01/08/2023]
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9
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Valero S, Bosch R, Corominas M, Giannoni A, Barrau V, Ramos-Quiroga JA, Casas M. Psychopathology and traffic violations in subjects who have lost their driving license. Compr Psychiatry 2017; 76:45-55. [PMID: 28411408 DOI: 10.1016/j.comppsych.2017.03.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 03/05/2017] [Accepted: 03/24/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The persistence of risky behaviors while driving and traffic accidents despite campaigns to increase awareness suggest that there may be underlying causes that maintain proneness to traffic violations. The aim of the current study was to assess: a) the prevalence of psychopathology in a sample of people who have lost their driving license due to former traffic violations and b) the discriminatory capacity of each psychopathological disorder to differentiate among people with high and low proneness to perform risky behaviors while driving. METHODS 383 participants in a course to recover their driving license after its loss due to previous traffic violations were included. The International Neuropsychiatric Interview (M.I.N.I.) according to DSM-IV was used to assess psychopathology. RESULTS Between 67% and 76.2% of the participants had been affected by a lifetime psychopathological disorder until the moment of assessment. The most prevalent diagnoses were substance abuse including alcohol (52.5-62.7%), ADHD (19.7-28.5%), depression (7.9-14.4%) and anxiety (3.6-12.4%). Substance abuse and ADHD also showed the strongest set of associations with specific risk behaviors, but ADHD emerged as the most discriminant disorder to distinguish between those people at high and low risk of while driving. CONCLUSIONS The results of the current study suggest that addressing psychopathology explicitly to prevent risky behaviors and recidivism while driving would provide benefits in this area.
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Affiliation(s)
- S Valero
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Center on Mental Health (CIBERSAM), Madrid, Spain.
| | - R Bosch
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Center on Mental Health (CIBERSAM), Madrid, Spain
| | - M Corominas
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Center on Mental Health (CIBERSAM), Madrid, Spain
| | - A Giannoni
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - V Barrau
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - J A Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Center on Mental Health (CIBERSAM), Madrid, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - M Casas
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Center on Mental Health (CIBERSAM), Madrid, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
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10
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Jung SY, Hwang B, Yang BR, Kim YJ, Lee J. Risk of motor vehicle collisions associated with medical conditions and medications: rationale and study protocol. Inj Prev 2016; 23:356. [PMID: 27597402 DOI: 10.1136/injuryprev-2016-042177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 08/11/2016] [Accepted: 08/12/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND Medical conditions and medications may be associated with motor vehicle collisions (MVCs), which pose a major public health problem worldwide. Further epidemiological assessment is necessary for certain diseases and medications. Moreover, since disease aetiology and patterns of medication use may differ among ethnicities and healthcare systems, a population-specific approach is necessary. The present epidemiological study is designed to assess the medical conditions and medications associated with the risk of fatal MVCs among at-fault drivers in the Korean population. METHOD AND DESIGN A retrospective cohort will be constructed for individuals who died in MVCs between 2005 and 2014 in the Korean Traffic Accident Analysis System database, which is linked to the Korean National Health Insurance database between 2002 and 2014. In order to compare medical conditions and medication use among drivers who died in a fatal MVC with the general population, standardised prevalence ratios will be calculated. In the culpability study, we will identify conditions and drugs associated with MVCs, comparing drivers with higher levels of responsibility to those with lower levels of responsibility. In the case-crossover study, the transient effects of medical conditions and medications will be examined using a conditional logistic regression model that adjusts for confounders. DISCUSSION The results of this study will help to characterise the associations of diseases and medications with fatal MVCs in an Asian population, with the goal of informing regulatory and clinical decision-making regarding patients with the relevant conditions and the establishment of strategies for improving traffic safety.
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Affiliation(s)
- Sun-Young Jung
- Office of Pharmacoepidemiology, Korea Institute of Drug Safety & Risk Management, Anyang, Korea
| | - Byungkwan Hwang
- Department of Neurology, Texas Tech University Health Science Center, Lubbock, Texas, USA
| | - Bo Ram Yang
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
| | - Ye-Jee Kim
- Department Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Korea
| | - Joongyub Lee
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea.,Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
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11
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Abstract
AIMS The main objective of this study was to see whether diabetes is associated with an increased collision risk and to test the effect of age and gender on the overall collision risk for diabetes drivers. MATERIALS AND METHODS Twenty-eight studies were included in meta-analysis, using mean age, gender, continent and the prevalence of fatal road incidents as covariates. RESULTS The collision risk for diabetes drivers was small and not statistically significant - RR = 1.11 (1.01-1.23) with a prediction interval (PI) or 0.77-1.65. Age and gender were not associated with an increased overall risk. Insulin-dependent diabetes patients had a slightly increased effect size compared with the overall diabetes population, but the effect was not statistically significant. European diabetes drivers had a lower collision risk compared with their North American counterparts, the main cause being the difference of collision risk in the countries in which the studies were performed. CONCLUSIONS Overall, diabetes patients do not have a statistically significant increased risk for unfavourable traffic events. Old age and insulin-dependent patients tend to have a higher risk. Advances in diabetes care, associated with advances in road safety regulations, and automotive industry have not decreased significantly the collision risk in the last 50 years for drivers with diabetes.
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Affiliation(s)
- S Hostiuc
- Department of Legal Medicine and Bioethics, Carol Davila University, Bucharest, Romania
- National Institute of Legal Medicine, Bucharest, Romania
| | - I Negoi
- Department of Surgery, Carol Davila University, Bucharest, Romania
| | - M Hostiuc
- Department of Internal Medicine and Gastroenterology, Carol Davila University, Bucharest, Romania
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12
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Kouvonen A, Vahtera J, Pentti J, Korhonen MJ, Oksanen T, Salo P, Virtanen M, Kivimäki M. Antidepressant use and work-related injuries. Psychol Med 2016; 46:1391-1399. [PMID: 26804130 DOI: 10.1017/s0033291715002925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Adverse effects of antidepressants are most common at the beginning of the treatment, but possible also later. We examined the association between antidepressant use and work-related injuries taking into account the duration of antidepressant use. METHOD Antidepressant use and work-related injuries between 2000 and 2011 were measured among 66 238 employees (mean age 43.8 years, 80% female) using linkage to national records (the Finnish Public Sector study). We analysed data using time-dependent modelling with individuals as their own controls (self-controlled case-series design). RESULTS In 2238 individuals who had used antidepressants and had a work-related injury during a mean follow-up of 7.8 years, no increase in the risk of injury was observed in the beginning of antidepressant treatment. However, an increased injury risk was seen after 3 months of treatment (rate ratio, compared with no recent antidepressant use, 1.27, 95% confidence interval 1.10-1.48). This was also the case among those who had used only selective serotonin reuptake inhibitors (n = 714; rate ratio 1.41, 95% confidence interval 1.08-1.83). CONCLUSIONS Antidepressant use was not associated with an increased risk of work-related injury at the beginning of treatment. Post-hoc analyses of antidepressant trials are needed to determine whether long-term use of antidepressants increases the risk of work-related injury.
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Affiliation(s)
- A Kouvonen
- Department of Social Research,University of Helsinki,Helsinki,Finland
| | - J Vahtera
- Finnish Institute of Occupational Health,Turku and Helsinki,Finland
| | - J Pentti
- Finnish Institute of Occupational Health,Turku and Helsinki,Finland
| | - M J Korhonen
- Department of Pharmacology, Drug Development and Therapeutics,University of Turku,Turku,Finland
| | - T Oksanen
- Finnish Institute of Occupational Health,Turku and Helsinki,Finland
| | - P Salo
- Finnish Institute of Occupational Health,Turku and Helsinki,Finland
| | - M Virtanen
- Finnish Institute of Occupational Health,Turku and Helsinki,Finland
| | - M Kivimäki
- Finnish Institute of Occupational Health,Turku and Helsinki,Finland
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13
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Graveling AJ, Frier BM. Driving and diabetes: problems, licensing restrictions and recommendations for safe driving. Clin Diabetes Endocrinol 2015; 1:8. [PMID: 28702227 PMCID: PMC5471925 DOI: 10.1186/s40842-015-0007-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/25/2015] [Indexed: 12/04/2022] Open
Abstract
Driving is a complex process that places considerable demands on cognitive and physical functions. Many complications of diabetes can potentially impair driving performance, including those affecting vision, cognition and peripheral neural function. Hypoglycemia is a common side-effect of insulin and sulfonylurea therapy, impairing many cognitive domains necessary for safe driving performance. Driving simulator studies have demonstrated how driving performance deteriorates during hypoglycemia. Driving behavior that may predispose to hypoglycemia while driving is examined. Studies examining the risk of road traffic accidents in people with insulin-treated diabetes have produced conflicting results, but the potential risk of hypoglycemia-related road traffic accidents has led to many countries imposing restrictions on the type and duration of driving licenses that can be issued to drivers with diabetes. Guidance that promotes safe driving practice has been provided for drivers with insulin-treated diabetes, which is the group principally addressed in this review.
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Affiliation(s)
- Alex J Graveling
- JJR Macleod Centre for Diabetes & Endocrinology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZP UK
| | - Brian M Frier
- The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, EH16 4TJ UK
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14
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Asbridge M, Cartwright J, Langille D. Driving under the influence of opioids among high school students in Atlantic Canada: prevalence, correlates, and the role of medical versus recreational consumption. ACCIDENT; ANALYSIS AND PREVENTION 2015; 75:184-191. [PMID: 25485729 DOI: 10.1016/j.aap.2014.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 11/17/2014] [Accepted: 12/01/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Employing a sample of 3655 senior students (grades 10 and 12, median ages of 16 and 18, respectively) in Atlantic Canada, this paper examines the risk factors associated with driving under the influence of opioids (DUIO), comparing medical versus recreational opioid users. The associations of DUIO with driving under the influence of alcohol, cannabis, and being a passenger of an impaired driver are also examined. METHODS Participants were drawn from the 2012 Student Drug Use Survey in the Atlantic Provinces, an anonymous cross-sectional survey of junior and senior high school students in three Atlantic Canadian provinces. Logistic regression techniques were employed in the analysis of unadjusted and adjusted models. RESULTS Among all senior students, the prevalence of DUIO in the past year was 4.3%. For those who had used a prescription opioid at least once in the past year, the rate of DUIO was 14%, with a higher rate among medical and recreational users (25.1%) compared to those using opioids only for medical purposes (9.6%). The predictors of DUIO were higher SES, higher sensation seeking, lower parental attachment, and being a recreational prescription opioid user. DUIO was strongly associated with other risky driving and passenger behaviours among recreational opioid users. CONCLUSIONS DUIO is an emerging socio-legal and road safety issue, with implications for public health. Prescription opioid use intentions matter, with recreational users exhibiting most risky driving behaviour than medical users. Effort must be placed on educating prescription opioid users about potential impairment while driving.
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Affiliation(s)
- Mark Asbridge
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, 5790 University Avenue, Halifax, NS B3H 1V7, Canada.
| | - Jennifer Cartwright
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, 5790 University Avenue, Halifax, NS B3H 1V7, Canada
| | - Donald Langille
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, 5790 University Avenue, Halifax, NS B3H 1V7, Canada
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16
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Abstract
Despite their improved pharmacokinetic profile, the Z-drugs, zolpidem, zopiclone, and zaleplon, have a spectrum of adverse effects comparable to benzodiazepines. This review focuses on the impairment from Z-drugs on cognition, behavior, psychomotor performance, and driving ability. Z-drugs are short-acting GABA agonists that reduce sleep latency without disturbing sleep architecture. Bizarre behavioral effects have prompted warnings on the prescription, dispensation, and use of Z-drugs. Psychomotor impairment, falls, and hip fractures are more likely to occur with Z-drugs that have longer half-lives, that are taken at higher-than-recommended doses and when mixed with other psychoactive substances including alcohol. Zopiclone and higher doses of zolpidem are more likely to cause anterograde amnesia than zaleplon. Z-drugs, especially zolpidem, are associated with complex behaviors such as sleepwalking, sleep-driving, and hallucinations. Patients taking zopiclone and zolpidem have an increased risk of motor vehicle collisions, over double that of unexposed drivers. Driving impairment occurs with zopiclone and higher doses of zolpidem but is unlikely to occur after 4 h post-zaleplon administration. The residual effect of Z-drugs on next-day cognitive and psychomotor performance has significant impact on lifestyle, safety, and occupational considerations, including motor vehicle and machine operation. The risk-benefit analysis of Z-drugs in the treatment of insomnia, particularly in the elderly, may not favor treatment due to the increased risks of falls and motor vehicle collisions. Prescribers should warn patients taking Z-drugs of minimum time thresholds before they operate machinery or drive motor vehicles.
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17
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Inkster B, Frier BM. Diabetes and driving. Diabetes Obes Metab 2013; 15:775-83. [PMID: 23350766 DOI: 10.1111/dom.12071] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 01/15/2013] [Accepted: 01/17/2013] [Indexed: 10/27/2022]
Abstract
The principal safety concern for driving for people treated with insulin or insulin secretagogues is hypoglycaemia, which impairs driving performance. Other complications, such as those causing visual impairment and peripheral neuropathy, are also relevant to medical fitness to drive. Case control studies have suggested that drivers with diabetes pose a modestly increased but acceptable and measurable risk of motor vehicle accidents compared to non-diabetic drivers, but many studies are limited and of poor quality. Factors which have been shown to increase driving risk include previous episodes of severe hypoglycaemia, previous hypoglycaemia while driving, strict glycaemic control (lower HbA1c) and absence of blood glucose monitoring before driving. Impaired awareness of hypoglycaemia may be counteracted by frequent blood glucose testing. The European Union Third directive on driving (2006) has necessitated changes in statutory regulations for driving licences for people with diabetes in all European States, including the UK. Stricter criteria have been introduced for Group 1 vehicle licences while those for Group 2 licences have been relaxed. Insulin-treated drivers can now apply to drive Group 2 vehicles, but in the UK must meet very strict criteria and be assessed by an independent specialist to be issued with a 1-year licence.
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Affiliation(s)
- B Inkster
- Department of Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK.
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18
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Wickens CM, Mann RE, Stoduto G, Ialomiteanu A, Smart RG, Rehm J. The impact of probable anxiety and mood disorder on self-reported collisions: a population study. J Affect Disord 2013; 145:253-5. [PMID: 23031745 DOI: 10.1016/j.jad.2012.04.046] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 04/25/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Individuals diagnosed with psychiatric disorder are at significantly increased risk of death and serious injury, to which motor vehicle collisions may be important contributors. This study examined the association between probable anxiety or mood disorder (AMD) and self-reported collision risk in a large representative sample of the adult population in Ontario. METHODS Based on data from a regionally stratified general-population telephone survey of adults conducted from 2002 through 2009 (N=12,830), a logistic regression analysis examined self-reported collision involvement in the previous 12 months by measures of demographic characteristics, driving exposure, impaired driving behaviour, and probable AMD. RESULTS Controlling for demographic variables and potential confounders, probable AMD was associated with an increased risk of collision involvement (OR=1.78, 95% CI=1.37, 2.31). LIMITATIONS The use of self-report measures and the potential for bias created by groups excluded because they do not have access to landline telephones represent limitations to the current findings. Nevertheless, the benefits of a large sample derived from general population survey data far outweigh these limitations. CONCLUSIONS The results suggest that the increased risk of injury and mortality associated with some psychiatric disorders is at least partially related to increased risk of collision involvement. The magnitude of the increase in risk associated with probable AMD is similar to that seen among individuals who drive after drinking or using cannabis. In view of these findings, more work to understand this risk among individuals experiencing probable AMD and how it can be avoided is necessary.
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Affiliation(s)
- Christine M Wickens
- Centre for Addiction and Mental Health, Social and Epidemiological Research Department, Toronto, Ontario, Canada.
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