Sleepiness, driving, and motor vehicle crashes. Council on Scientific Affairs, American Medical Association.

OBJECTIVE: To assess the contribution of driver sleepiness to highway crashes and review recent recommendations to change federal hours-of-service regulations for commercial motor vehicle drivers. DATA SOURCES: Information was derived from a search of the MEDLINE, Transportation Research Information Service (TRIS), and Bibliographic Electronic Databases of Sleep (BEDS) databases from 1975 through 1997 and from manual review of the reference lists in relevant journal articles, government publications, conference proceedings, and textbooks. DATA SYNTHESIS: Driver sleepiness is a causative factor in 1% to 3% of all US motor vehicle crashes. Surveys of the prevalence of sleepy behavior in drivers suggest that sleepiness may be a more common cause of highway crashes than is reflected in these estimates. About 96% of sleep-related crashes involve passenger vehicle drivers and 3% involve drivers of large trucks. Risk factors include youth, shift work, alcohol and other drug use, over-the-counter and prescription medications, and sleep disorders. CONCLUSIONS: Increased awareness of the relationship between sleepiness and motor vehicle crashes will promote the health and safety of drivers and highway users. Physicians can contribute by encouraging good sleep habits, recognizing and treating sleep-related problems, and counseling patients about the risks of driving while sleepy. To protect public health and safety, the American Medical Association recommends continued research on devices and technologies to detect the signs of sleepiness and prevent the deterioration of driver alertness and performance. Educational programs about the risks of falling asleep while driving are needed for physicians, the public, and commercial truck drivers.

Understanding and preventing injuries.

Unintended injuries have become the third most frequent cause of death in the United States, and the relative importance of homicide and suicide has also increased. In recent decades, death rates from highway crashes and fires have fallen, and experience indicates that serious injuries in the workplace can be drastically reduced. Less progress has been made in preventing homicide and suicide. Tasks for the future include more research on the efficacy of preventive interventions, improvement of injury surveillance and prevention programs, and education of children and adults about injury prevention. Family physicians can play an important role in injury prevention efforts.

Radon in homes: determining risks and preventing exposures.

Knowledge about the effects of radon disintegration products and their levels in the nation's homes indicates that in a small proportion of homes these radioactive substances are increasing the inhabitants' risks of lung cancer. Testing for the problem and reducing its magnitude are the homeowner's responsibility. While practical methods for testing are known, they may not be easily available in all regions. Present understanding of the techniques of prevention and remediation is less satisfactory.

Origin and health risks of indoor radon.

Radon has always been a component of ground and air and it has been present in increased concentrations from the moment humans first sought shelter inside dwellings. Recent improvements in the energy efficiency of dwellings have led to increased concentrations of radon and to increased risks of lung cancer. To quantify the magnitude of this risk, well-designed epidemiological studies, including surveys of representative dwellings, are needed, and several are being implemented. In the meantime, the EPA and other agencies have offered guidance on monitoring procedures and remedial measures appropriate for the problem on indoor radon. Recent disclosures of relatively high concentrations of radon and radon decay products in homes in several parts of the country have increased public concern about the problem. More information and education are needed about the health risks of radon, the desirability of implementing monitoring procedures for radon, and about remediation measures when detected levels are above average. Educational resources are needed in communities to address local issues when they arise. These resources should include knowledgeable individuals who can work with state and county health officials to put public concerns into perspective within the local context. Physicians, other health professionals, and medical scientists have the knowledge and credentials to be these individuals. To provide health professionals with knowledge and skills to communicate with the public about the health risks of radon, the American Medical Association has prepared an authoritative report and initiated a series of regional seminars on the origin and health risks of radon.(ABSTRACT TRUNCATED AT 250 WORDS)

Athletes' Use and Abuse of Drugs.

In brief: This article presents a review of the literature on drug misuse by athletes and information from 16 sports and medical organizations whose representatives met in 1985 to discuss the problem. Studies of drug use by athletes are relatively few. Existing data do not show a difference in drug use between athletes and nonathletes, but anabolic steroids probably are used more widely among athletes. Our review disclosed little evidence that drugs can improve an athlete's performance without also posing the threat of serious harm. Major sports organizations have banned the use of anabolic steroids, stimulants, diuretics, analgesics, beta-adrenergic blockers, cocaine, marijuana, and heroin, and some have begun testing athletes. Physicians should assist efforts to prevent the illegal distribution of drugs and should help with existing education and testing programs.

A review of the medical standards for civilian airmen. Synopsis of a two-year study.

This article summarizes the report of a comprehensive review by the American Medical Association (AMA) of the medical standards for civilian airmen. The present standards were promulgated by the Federal Aviation Administration in 1959; the alcoholism and cardiovascular standards were revised in 1982. The AMA report recommends new or revised standards for cardiovascular, mental and behavioral, visual, endocrine, respiratory, hematological, hearing and equilibrium, musculoskeletal, and nervous system disorders. It also provides guidance for the medical certification of airmen with conditions not covered specifically by the standards and recommends a new medical history and examination form for use by aviation medical examiners. Risk factors for the development of sudden incapacitating disease, such as coronary heart disease and stroke, receive special attention. Final standards will be developed by the Federal Aviation Administration.

A model for epidemiologic research.

Health sciences students should understand the fundamentals of epidemiologic methods that can lead to major advances in the treatment of disease. To this end, the research process is defined and a three-dimensional model that considers some basic elements of epidemiologic research--time, place, and strategy--is described. The strategies available to the investigator (descriptive, analytic, and experimental) and the possible time frames (retrospective, concurrent, and prospective) are illustrated in terms of field investigations that involve problems of infection, nutrition, dysplasia, metabolism, and cancer. It is believed that epidemiologic studies, no matter where they are performed, have certain features in common, especially those related to the elements of strategy and time.