Medication Use ADD ADHD and Risk of Motor Vehicle Crashes

 Is there a relationship between medication use and a LOWER risk of accidents? 

Yes. 

Short term? Yes.

Long-term? Yes.

Men? Yes.

Women? Yes. 

Please take your medicines. 

Association Between Medication Use for Attention-Deficit/Hyperactivity Disorder and Risk of Motor Vehicle Crashes

Question

Is the use of attention-deficit/hyperactivity disorder medication associated with a reduced risk of motor vehicle crashes in patients with the disorder?

Findings

In a national cohort study of 2 319 450 patients with attention-deficit/hyperactivity disorder, the use of medication for the disorder was associated with a significant reduction in the risk of motor vehicle crashes in male and female patients.

Meaning

Attention-deficit/hyperactivity disorder medication use may lower the risk of motor vehicle crashes, a prevalent and preventable cause of mortality and morbidity among patients with the disorder.

ADHD & Accidents Crashes Violations Suspensions in Motor Vehicles - New Data

 Do teens with ADHD have more accidents? More Moving Violations?

Yes. For Years,

Traffic Crashes, Violations, and Suspensions Among Young Drivers With ADHD

Allison E. Curry, PhD, MPH,a,b Benjamin E. Yerys, PhD,c,d Kristina B. Metzger, PhD, MPH,a Meghan E. Carey, MS,a and Thomas J. Power, PhDb,d

Abstract

Methods: We identified patients of New Jersey primary care locations of the Children's Hospital of Philadelphia who were born in 1987-1997, were New Jersey residents, had their last primary care visit at age ≥12 years, and acquired a driver's license (N = 14 936). Electronic health records were linked to New Jersey's licensing, crash, and violation databases. ADHD diagnosis was based on International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes. We calculated monthly per-driver rates of crashes (at fault, alcohol related, nighttime, and with peers), violations, and suspensions. Adjusted rate ratios were estimated by using repeated-measures Poisson regression.

Objectives: To compare monthly rates of specific types of crashes, violations, and license suspensions over the first years of licensure for drivers with and without attention-deficit/hyperactivity disorder (ADHD).

Results: Crash rates were higher for drivers with ADHD regardless of licensing age and, in particular, during the first month of licensure (adjusted rate ratio: 1.62 [95% confidence interval: 1.18-2.23]). They also experienced higher rates of specific crash types: their 4-year rate of alcohol-related crashes was 2.1 times that of drivers without ADHD. Finally, drivers with ADHD had higher rates of moving violations (for speeding, seat belt nonuse, and electronic equipment use) and suspensions. In the first year of driving, the rate of alcohol and/or drug violations was 3.6 times higher for adolescents with ADHD.

Conclusions: Adolescents with ADHD are at particularly high crash risk in their initial months of licensure, and engagement in preventable risky driving behaviors may contribute to this elevated risk. Comprehensive preventive approaches that extend beyond current recommendations are critically needed.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6564068/figure/fig2/?report=objectonly

Insomnia raises risk of fatal injury

Having insomnia can raise a person's risk of death by motor vehicle and other fatal injuries.

New research suggests that insomnia is a major contributor to deaths caused by motor vehicle crashes and other unintentional fatal injuries. The results underscore the importance of the "Sleep Well, Be Well" campaign of the National Healthy Sleep Awareness Project.

Results show that the risk of unintentional fatal injury increased in a dose-dependent manner with the number of insomnia symptoms present. People with all three symptoms of insomnia were 2.8 times more likely to die from a fatal injury than those with no insomnia symptoms, even after adjusting for potential confounders such as alcohol consumption and daily use of sleep medication.

Among the three insomnia symptoms, difficulty falling asleep appeared to have the strongest and most robust association with fatal injuries. People who almost always had difficulty falling asleep were more than two times more likely to die from a motor vehicle injury (hazard ratio = 2.40) and more than 1.5 times more likely to die from any fatal injury (HR = 1.66) than people who never had trouble initiating sleep. Further analysis found that self-reported difficulty falling asleep contributed to 34 percent of motor vehicle deaths and eight percent of all unintentional fatal injuries, which could have been prevented in the absence of insomnia.

"Our results suggest that a large proportion of unintentional fatal injuries and fatal motor vehicle injuries could have been prevented in the absence of insomnia," said lead author Lars Laugsand, MD, PhD, postdoctoral fellow in the department of public health at the Norwegian University of Science in Technology in Trondheim, Norway. "Increasing public health awareness about insomnia and identifying and treating people with insomnia may be important in preventing unintentional fatal injuries."

The study results are published in the November issue of the journal Sleep.

"Healthy sleep is essential for physical health, mental well-being, and personal and public safety," said American Academy of Sleep Medicine President Dr. Timothy Morgenthaler, a national spokesperson for the Healthy Sleep Project. "Sleep is a necessity, not a luxury, and the promotion of healthy sleep should be a fundamental public health priority."

Earlier this year the Healthy Sleep Project launched the "Sleep Well, Be Well" campaign to increase awareness of the importance of sleep as one of the three pillars of a healthy lifestyle. More details are available at http://www.projecthealthysleep.org.

The study involved that analysis of population-based survey data from 54,399 men and women between 20 and 89 years of age. Cause of death was identified using a national registry. During the 13-year follow-up period there were 277 unintentional fatal injuries, including 169 deaths from falls and 57 deaths from motor vehicle crashes.

According to the Centers for Disease Control and Prevention, there are more than 126,000 unintentional injury deaths in the U.S. each year, making it the fifth leading cause of death. There are more than 33,000 motor vehicle traffic fatalities and more than 27,000 unintentional fall deaths annually, as well as 29.3 million emergency department visits related to unintentional injuries.

Read more here

Children with epilepsy at higher risk of injury

A study looks at epileptic children and found that they are at a significantly higher risk of injury than children without epilepsy.

Children and young adults with epilepsy are more likely to suffer broken bones, burns and poisonings compared to those without the neurological disorder, new research has found.

The study, led by academics at The University of Nottingham and funded by the National Institute for Health Research, shows that young people with the condition are at significantly greater risk of being poisoned by medication, leading the authors to call for further research into whether these poisonings are intentional.

The results, taken in tandem with previous research findings, highlight the need for further research into whether young people with the condition are at greater risk from an overdose, accidental or intentional, of their epilepsy drugs or other medication. And the researchers say that doctors and other healthcare professionals should use the results of the study to help warn epilepsy patients of the increased risk associated with their illness.

The study, published in the latest edition of the journal Pediatrics, found that young people with epilepsy were more than twice as likely to be poisoned by medication. This jumped to four times the risk in patients aged between 19 and 24 years old.

The patients, all aged between 12 months and 24 years old at the time of their diagnosis, were also almost one and a half times more likely to suffer a burn-related injury and almost 25 per cnet more at risk of breaking an arm or leg.

Dr Vibhore Prasad, of the University’s Division of Primary Care, said: “More research is needed to understand why people with epilepsy have a greater number of medicine-related poisonings and whether the poisonings are intentional or accidental. This is the first study in the UK population to estimate the risk of fractures, burns and poisonings. The risk of a poisoning in the next five years for 1,000 people with epilepsy is about 20 extra poisonings compared to people who do not have epilepsy.”

Epilepsy is a chronic condition caused by a sudden burst of electrical activity in the brain, causing a temporary interruption in the way the brain normally works and resulting in a seizure. In the UK alone there are more than 600,000 people with epilepsy.

Previous studies into the condition have suggested that these seizures — and the side effects caused by some anti-epilepsy drugs — put patients at a greater risk of accidental injuries.

However, most research may have overestimated this risk because they focused primarily on people with more severe epilepsy, such as institutionalised adults or those being treated in epilepsy clinics.

This latest study is the first to investigate the potential risk of injury exclusively in children and young people with and without epilepsy.

The research, which was carried out in association with academics at the London School of Hygiene and Tropical Medicine, used GP records from almost 12,000 patients with epilepsy to study the incidence of injury over an average of two and a half years and compared it with the records of around 47,000 non-epileptic people.

The authors say that doctors and other healthcare professionals can use the findings of the research to make children and young adults diagnosed with epilepsy, and their parents, more aware of the risk of injury and to inform existing guidelines on treatment. In particular, they cite the need for more information relating to the safe storage of medicines and the supervision of children while taking their medication to be given by doctors at the time of prescribing and by pharmacists when dispensing prescriptions.

Read more here

Reasons why the NFL's new concussion rules aren't working

This article details issues with the NFL's new concussion rules and determines that the issues in football safety lie inherently within the sport.

In January, the NFL announced that, starting with the 2013 season, all games would be played with an independent neurologist on the sidelines to assist with the evaluation and treatment of head injuries. It looked like the league had done a good thing. It was establishing a new, unbiased procedure to promote player safety—an effort made all the better by the fact that it didn't involve placing the burden on the players themselves.

But the fundamental problem with football safety is football, and the league's new program is proving it.

Let's start with some background on the new rule. The players union had long demanded that the league require the presence of independent neurotrauma specialists who could evaluate players without interference or influence from any teams. To wit: On the same day the NFL made its announcement, the NFLPA cited a poll indicating that 78 percent of players didn't trust their own teams' medical staffs.

The league's decision to require these unaffiliated consultants was announced at a news conference held just before the NFLPA's annual Super Bowl week news conference. Also on that same day, NFLPA executive director DeMaurice Smith said the union had not been notified of the league's plan to make the change. And all this was at a time when the NFL was still preparing for a court battle against the concussion-related lawsuits involving thousands of former players who accused it of distorting information about the long-term effects of head trauma. Those suits have since been settled.

The two sides eventually smoothed over their differences, and soon the NFLPA was on board with the plan to have independent neurologists on the sidelines. An NFLPA spokesman told me the league and the union have since worked out an agreement by which they both have input in selecting those independent sideline consultants. Those consultants are picked from a list of experts in all 31 NFL cities. The consultants must not be affiliated with any NFL teams. TheNFL's concussion protocol also spells out that the each consultant must be "board certified or board eligible in neurology, neurological surgery, emergency medicine, physical medicine and rehabilitation or any primary care CAQ sports medicine certified physician and [have] documented competence and experience in the treatment of acute head injuries." Since last year, the protocol also mandates that an athletic trainer must be present up in the booth serve as a "spotter" for both teams by reviewing video and replay technology.

So what could go wrong? Why would there be any problems with diagnosing and handling concussions? Let's look at three situations involving three players in three games. Each one illustrates what the NFLPA spokesman told me was an "area of concern" for the players association after the first month of the new season.

The scenario: In Week 1, Jeremy Kerley of the Jets was concussed when he caught a pass over the middle toward the end of the first half against the Bucs. Kerley was hit by three different players, and Tampa's Mark Barron was flagged for unnecessary roughness:

Kerley was taken to the locker room and given the concussion tests, but he later returned to the game. The following day, he was held out of practice when he was evaluated again and diagnosed with concussion symptoms. The Jets had a short week heading into their next game, and Kerley missed their Week 2 game against the Patriots before returning to play in Week 3 against the Bills. 

The problem: Players don't always show concussion symptoms immediately.

The scenario: In Week 3, the Raiders' Terrelle Pryor took a helmet-to-helmet hit from the Broncos' Wesley Woodyard. Pryor had tucked the ball and made himself a runner, and the hit occurred inside the tackle box, so Woodyard was not penalized:Pryor lay on the turf momentarily but played two more snaps. After the Raiders turned the ball over on downs, he started showing symptoms during a sideline evaluation and was removed from the game. The next day, Pryor tweeted, "I don't remember much!" He returned to practice in a limited role later in the week and was ultimately held out of Sunday's game against the Redskins. The league's concussion protocol says that "if the occurrence of a concussion is unclear, or a player sustains a mechanism of injury ('big hit') that is reasonably expected to give rise to a concussion... the player shall be removed immediately from the field by Club medical personnel." The hit Pryor took certainly seems to fit that definition, and the NFLPA isinvestigating the Raiders' handling of Pryor to determine why he remained in the game. Per Mike Florio, the NFLPA does not want the typical sideline chaos to be used as an excuse for any failure to be properly vigilant in following the mandated protocols. The union spokesman told me that, depending on the outcome of its investigation, the NFLPA could consider filing a grievance.

The problem: A possible breakdown in protocol.

The scenario: In Week 2, Steelers running back Isaac Redman was injured on the opening kickoff after taking a helmet-to-helmet hit from the Bengals' Jayson DiManche. Redman was blocking on the play, and the collision happened away from the ball. Here, you can see Redman go down around the 30-yard line just as the action stops:

The problem: The tendency of players to not want to come out of the game.

These aren't rare, exotic scenarios. They're all things that come up normally in the course of play, like two-point conversions and onside kicks, and that's the issue. The new program is designed to keep concussed players from playing, yet that's not what's happening. These are problems that can't be solved via fiat and bureaucracy, and there's a simple inference to be drawn from that fact: you can't really fix football without turning it into another sport.

Read more, and see the videos referenced here