The Spanish pictogram on medicines and driving: The population's comprehension of and attitudes towards its use on medication packaging.

The Spanish pictogram on medicines and driving is legally binding since 2011. We have evaluated patients' comprehension, change in driving frequency and the perceived usefulness, information, comprehensibility, and simplicity of this pictogram on 1385 Spaniards users of the National Health Service (pharmacies, primary care and hospital centres). Most, 85.7%, correctly related the symbol with the possible effects of the medicine on driving and the 83.9% of the drivers would reduce the frequency with which they drive when prescribed a medicine with such pictogram. The pictogram was found, in a 10-point Likert, useful (8.3±1.7), informative (7.7±1.9), comprehensible (7.8±1.9) and simple (7.8±1.9). The Spanish pictogram on medicines and driving is understood by the great majority of those interviewed; is well considered by the users of the National Health Service; and offers good prospects for reinforce the awareness of health care professionals and patients on the effects of medicines on driving.

Prevalence of psychoactive substances, alcohol, illicit drugs, and medicines, in Spanish drivers: a roadside study.

Following population, geographic, road type and time criteria, Spain has carried out random, roadside controls of 3302 representative sample of Spanish drivers, including saliva analysis for 24 psychoactive substances and alcohol breath tests. The 81.4% of the drivers were male, with an average age of 34.8±11.8 (mean±SD). The 17% of the drivers were found to be positive to any of the substances analysed. The 6.6% of the drivers found positive to alcohol (>0.05 mg/l in breath), 11% were found positive to any illicit drug, and 2% were positive to one of the medicines analysed. Some drivers were positive in more than one substance. The most common illicit drugs among Spanish drivers were cannabis (7.7%), or cocaine (3.5%), either alone or combined with other substances. The most prevalent medicines were the benzodiazepines (1.6%). As a tendency, higher figures for positive cases were observed among males than in females (being statistically significant the differences for alcohol, cannabis and cocaine). Alcohol and cocaine positive cases were more frequently found among drivers of urban roads. Alcohol positive cases (alone, >0.05 mg/l), were more likely found as age increase (OR=1.02), those driving in urban roads (OR=2.13), and driving at any period than weekdays, while alcohol+drugs cases were more likely found among males (OR=2.819), those driving on urban road (OR=2.17) and driving at night periods. Finding a medicines positive case was more likely as elder the driver was (OR=1.05). There have been differences in the prevalence of positive cases of alcohol, cannabis and cocaine, in relation to the period of the week: in three cases the highest prevalence seen in night time. This study shows the high prevalence of psychoactive substances and alcohol in Spanish drivers, mainly illicit drugs (cannabis). This question requires a response from the authorities and from society, with an integral and multi-disciplinary approach that can heighten the population's awareness of the risks of driving under the influence of certain substances.

A European approach to categorizing medicines for fitness to drive: outcomes of the DRUID project.

AIMS: To illustrate (i) the criteria and the development of the DRUID categorization system, (ii) the number of medicines that have currently been categorized, (iii) the added value of the DRUID categorization system and (iv) the next steps in the implementation of the DRUID system. METHODS: The development of the DRUID categorization system was based on several criteria. The following steps were considered: (i) conditions of use of the medicine, (ii) pharmacodynamic and pharmacokinetic data, (iii) pharmacovigilance data, including prevalence of undesirable effects, (iv) experimental and epidemiological data, (v) additional data derived from the patient information leaflet, existing categorization systems and (vi) final categorization. DRUID proposed four tiered categories for medicines and driving. RESULTS: In total, 3054 medicines were reviewed and over 1541 medicines were categorized (the rest were no longer on the EU market). Nearly half of the 1541 medicines were categorized 0 (no or negligible influence on fitness to drive), about 26% were placed in category I (minor influence on fitness to drive) and 17% were categorized as II or III (moderate or severe influence on fitness to drive). CONCLUSIONS: The current DRUID categorization system established and defined standardized and harmonized criteria to categorize commonly used medications, based on their influence on fitness to drive. Further efforts are needed to implement the DRUID categorization system at a European level and further activities should be undertaken in order to reinforce the awareness of health care professionals and patients on the effects of medicines on fitness to drive.

[Road-rage in the general population]. / Agresividad vial en la población general.

OBJECTIVE: To analyze the prevalence of road rage in the general population and the sociodemographic factors associated with this phenomenon. METHODS: A total of 2,500 interviews were carried out in the population of Castile and Leon aged 14-70 years. Road rage was evaluated in the year prior to the survey using a test with eight questions. RESULTS: One-third (31.1%) of the interviewees reported they had experienced a situation involving road rage during the previous 12 months (26.8% on more than one occasion). Among these episodes, 2.6% involved "serious" aggressors. In drivers, the probability of experiencing road rage increased in line with the number of kilometers driven per week (odds ratio [OR]=1.52), decreased as the age of the driver increased (OR=0.975), and was highest in men (OR=1.287), university graduates (OR=1.408), and persons living in towns with over 10,000 inhabitants (OR=1.25). CONCLUSIONS: The results of this study show that road rage affects almost a third of the general population of Castile and Leon, which would amply justify the adoption of prevention and/or reduction measures.

Agresividad vial en la población general / Road-rage in the general population

Objetivos Analizar la prevalencia y los factores sociodemográficos asociados con la agresividad vial en la población. Métodos Se han realizado 2.500 entrevistas a la población de Castilla y León de entre 14 y 70 años de edad. Se evaluó la agresividad vial en el año previo a la realización de la encuesta utilizando un test de ocho preguntas.Resultados El 31,1% refirió haber vivido alguna situación de agresividad vial en el último año, y el 26,8% en más de una ocasión. El 2,6% fueron agresores viales «graves». Entre los conductores, la probabilidad de experimentar agresividad vial aumenta a medida que aumentan los miles de kilómetros conducidos a la semana (odds ratio [OR]=1,52), es menor cuanto mayor es la edad del entrevistado (OR=0,975) y es mayor en los hombres (OR=1,287), en los que tienen estudios universitarios (OR=1,408) y en los que viven en localidades de más de 10.000 habitantes (OR=1,25).Conclusiones Los datos del presente estudio muestran que la agresividad vial afecta a casi un tercio de la población general de Castilla y León, lo que justificaría la adopción de medidas para su prevención y reducción (AU)

Objective To analyze the prevalence of road rage in the general population and the sociodemographic factors associated with this phenomenon.Methods A total of 2,500 interviews were carried out in the population of Castile and Leon aged 14-70 years. Road rage was evaluated in the year prior to the survey using a test with eight questions.Results One-third (31.1%) of the interviewees reported they had experienced a situation involving road rage during the previous 12 months (26.8% on more than one occasion). Among these episodes, 2.6% involved “serious” aggressors. In drivers, the probability of experiencing road rage increased in line with the number of kilometers driven per week (odds ratio [OR]=1.52), decreased as the age of the driver increased (OR=0.975), and was highest in men (OR=1.287), university graduates (OR=1.408), and persons living in towns with over 10,000 inhabitants (OR=1.25).Conclusions The results of this study show that road rage affects almost a third of the general population of Castile and Leon, which would amply justify the adoption of prevention and/or reduction measures (AU)

Accident rates for drug-dependent patients in treatment for substance dependence: a pilot trial.

OBJECTIVES: To analyze accident rates among drug-dependent patients before and after treatment for substance dependence. METHODS: Self-reported lifetime data and data from the year prior to the start of treatment were analyzed from a cohort including 53 drug-dependent patients, 48 men and 5 women, who had started treatment for substance dependence in an outpatient treatment center in Valladolid, Spain. We also obtained prospective information about treatment dropout and accident rates in the 3-month follow-up period after the start of drug-dependency treatment. RESULTS: Twenty-two percent of drug-dependent patients had an accident in the year prior to starting treatment, and 64.2 percent had an accident in his or her lifetime. Road traffic accidents were the most frequent, with 11.3 percent of patients reporting at least one in the prior year and 45.3 percent reporting at least one road traffic accident in his or her lifetime. Furthermore, drug-dependent patients were frequently under the influence of drugs when driving (13.2%), as well as when performing dangerous activities at work (11.3%), at home (9.4%), and during sporting activities (5.7%) in the year prior to starting treatment. Of the 30 patients who were still undergoing treatment after 3 months, 2 had had accidents during this period (6.6%), one occurring at work and the other at home. CONCLUSIONS: Accident involvement, and especially involvement in road traffic accidents, was common among drug-dependent patients. Many accidents occurred in the year prior to treatment initiation. Furthermore, drug-dependent patients often undertook risky activities while under the influence of drugs. There is a need to implement accident prevention strategies, especially strategies that target road traffic accidents, in treatment programs for drug-dependent patients.

Assessment of fitness to drive and cardiovascular diseases at the Spanish medical traffic centres.

BACKGROUND: There is an increased risk of automobile accidents in patients with some cardiovascular disorders and licensing authorities have imposed certain restrictions on such persons. Experience assessing fitness to drive among drivers with cardiovascular disorders, and the relevance of other associated medical conditions among drivers assessed as unfit, are reported here. METHODS AND RESULTS: The study included 5,234 drivers attending 2 Spanish Medical Driver Test Centres to assess their fitness to drive. Information regarding sociodemographic aspects, driving patterns, medical conditions, medication use and alcohol consumption patterns was recorded: 11.6% of the drivers had a cardiovascular disorder that potentially impaired fitness to drive, 82.5% were found fit to drive, 15.9% were fit to drive with restrictions and 1.6% were unfit. The 10 unfit patients with cardiovascular disorders were primarily considered unfit because of their associated ophthalmologic and medical comorbidities, but the cardiovascular disorders were a contributing factor. CONCLUSION: Most (98.4%) drivers with cardiovascular disorders will be completely fit to drive or fit to drive with restrictions. There is a need for a personalized evaluation of fitness to drive for each driver/patient, taking into account such aspects as the associated pathology, the taking of medicinal drugs and alcohol consumption.