Gian Luca Rosso

Investigating obesity among professional drivers: The high risk professional driver study

OBJECTIVE The aim of this study is to detect the main individual and transportation factors associated with obesity and its prevalence among Italian professional drivers (PDs). METHODS We performed a cross-sectional questionnaire survey. Data from PDs (n = 497) were used for analyses. RESULTS Sixty-one percent of participants were either overweight or obese according to their body mass index. Predictive factors for obesity were traveling more than 40,000 miles per year (odds ratio [OR] 4.20, confidence interval [CI] 1.41-12.56) and hours spent behind the wheel per day (OR 1.27, CI 1.02-1.58). Bus drivers had half the risk of being obese compared to truck drivers (OR 0.45, CI 0.23-0.87). An inverse association was detected between educational attainment and obesity (OR 0.32, CI 0.11-0.90). CONCLUSIONS PDs with high number of driving hours per day, miles driven per year, and low educational level should be subject to special educational programs to reduce and prevent obesity.

Workplace drug testing and alcohol policy in Italy; There is still a long way to go

The effectiveness of workplace drug testing (WDT) in Italy has recently been questioned, while very little is known about the real consumption of alcoholic beverages among workers performing hazardous jobs, such as professional drivers (PDs). The aim of this study is to investigate the modality and frequency of WDT execution and of alcohol consumption in the above category. Anonymous questionnaires were used to collect information. Four hundred and ninety-seven questionnaires were collected; 50.1% declared that they know well in advance when they will be subjected to screening tests for drugs, while 19.5% claimed they have never been subjected to such a test. The greater the number of employees in a company, the greater the likelihood that the tests are performed with a genuinely surprise effect [odds ratio (OR) 2.41, 5.39 and 9.07, respectively, for businesses with 5-14 employees, 15-50 and more than 50, compared with companies with less than 5 employees, p < 0.01]. Twenty-one point four percent declared they drink alcoholic beverages during working hours or work breaks. This attitude is positively correlated with driver seniority [OR 1.07, 95% confidence interval (CI) 1.03-1.11 p < 0.01] and is more common in those who operate on mainly international routes (OR 3.34 CI 1.30-8.59 p < 0.01) and only occasionally consume meals in restaurants (OR 4.27, CI 1.19-15.42 p < 0.05). Fifteen percent of the participants have an AUDIT C score ≥ 5. In conclusion WDT is largely ineffective, particularly in small businesses. The high percentage of PDs who claim to drink during working hours and who are hazardous drinkers requires a further strengthening of prevention strategies in this area.

Role of galectin-3 and plasma B type-natriuretic peptide in predicting prognosis in discharged chronic heart failure patients.

AbstractGalectin-3 demonstrated to be a robust independent marker of cardiovascular mid-term (18-month) outcome in heart failure (HF) patients. The objective of this study was to analyze the value of a predischarged determination of plasma galectin-3 alone and with plasma brain natriuretic peptide (BNP) in predicting mid-term outcome in frequent-flyers (FF) HF (≥2 hospitalization for HF/year)/dead patients discharged after an acute decompensated HF (ADHF) episode.All FF chronic HF subjects discharged alive after an ADHF were enrolled. All patients underwent a determination of BNP and galectin-3, a 6-minute walk test, and an echocardiogram within 48 hours upon hospital discharge. Death by any cause, cardiac transplantation, and worsening HF requiring readmission to hospital were considered cardiovascular events.Eighty-three patients (67 males, age 73.2 ± 8.6 years old) were analyzed (mean follow-up 11.6 ± 5.2 months; range 4–22 months). During the follow-up 38 events (45.7%) were scheduled: (13 cardiac deaths, 35 rehospitalizations for ADHF). According to medical history, in 33 patients (39.8%) a definition of FF HF patients was performed (range 2–4 hospitalization/year). HF patients who suffered an event (FF or death) demonstrated more impaired ventricular function (P = 0.037), higher plasma BNP (P = 0.005), and Gal-3 at predischarge evaluation (P = 0.027). Choosing adequate cut-off points (BNP ≥ 500 pg/mL and Gal-3 ≥ 17.6 ng/mL), the Kaplan–Meier curves depicted the powerful stratification using BNP + Gal-3 in predicting clinical course at mid-term follow-up (log rank 5.65; P = 0.017).Adding Gal-3 to BNP, a single predischarge strategy testing seemed to obtain a satisfactorily predictive value in alive HF patients discharged after an ADHF episode.

AUDIT-C score and its association with risky behaviours among professional drivers

BACKGROUND: Hazardous alcohol use has been associated with risk-taking behaviours whilst driving. There is some limited information about the relationship between heavy alcohol consumption and alcohol consumption in the workplace (ACW) - during working hours or lunch breaks - and driving dangerously. METHODS: We conducted a cross-sectional questionnaire survey with Italian professional drivers enrolled in professional driving courses. Using logistic regression models, we examined whether the Alcohol Use Disorders Test-Consumption (AUDIT-C) score was associated with ACW and with some of the most common risky driving behaviours (hand-held cell phone use, text messaging, PC use, reading, TV watching). RESULTS: Of the 377 participants, 89 (23.6%) admitted ACW (19 [5%] rarely, 37 [9.8%] frequently and 33 [8.8%] daily) and 305 (81.8%) reported at least one of the risky driving behaviours mentioned above (107 [28.7%] rarely, 95 [25.5%] frequently and 103 [27.6%] daily). Taking as outcomes variables ACW and risky driving behaviour (yes=frequently or daily/no=never or rarely), the AUDIT-C score was significantly associated with these behaviours (adjusted odds ratios [AOR] 1.45 and AOR 1.15, respectively). An AUDIT-C cut-off ≥4 (instead of ≥5, as suggested by some Italian regional laws) was more reliable in identifying PDs with risky behaviours. CONCLUSION: The AUDIT-C questionnaire is an effective alcohol-screening tool and can help to identify not only high-risk drinkers but also those with increased risk of ACW and risky driving behaviours. PDs with an AUDIT-C ≥4 should be a target for harm reduction or preventive measures. Language: en

Falling asleep at the wheel and distracted driving. The High-Risk Professional Drivers study

BACKGROUND Sleepiness at the wheel and driving while engaged in other activities are well known risk factors for traffic accidents. This article estimates the prevalence of these factors among Italian Professional Drivers (PDs) and their impact on reported driving mistakes. METHODS A cross-sectional study was conducted using anonymous questionnaires. PDs (n=497) were divided into two groups: high-risk PDs (HiRis_PDs) (those who self-reported more than one incident during the last 3 years and/or more than one mistake during the past year) and non-HiRis_PDs (subjects who did not meet the above-mentioned inclusion criteria). Logistic regression analyses were performed to assess the association of self-reported sleepiness and/or risky driving behaviour with the condition of being a high-risk driver. RESULTS 161 (32.4%) subjects were defined as HiRis_PDs. Forty-one percent of the interviewees experienced at least one episode per month of sudden-onset sleep at the wheel. Twenty-eight point two percent reported a regular use of a hand-held cell phone. Predictive factors for being HiRis_PDs were: at least one self-reported episode per month of falling asleep at the wheel [odds ratio (OR) 5, 95% confidence interval (CI) 3.21-7.80, P<0.001], driving while regularly engaged in other activities (mainly hand-held cell phone use) (OR 6.11, 95% CI 2.90-12.84, P<0.001), and young age (OR 0.96, OR 1 year of age increase, 95% CI 0.94-0.98, P=0.001). CONCLUSIONS Focusing prevention efforts on recognizing sleepiness at the wheel and on avoiding other distracting activities while driving can reduce the possibility of driving errors on the road by about 5-6 times.

The Predictive Value of Plasma Brain Natriuretic Peptide and Galectin-3 in Elderly Patients Admitted for Heart Failure

Galectin-3 is demonstrated to be a robust independent marker of cardiovascular mid-term (18-month) outcomes in heart failure (HF) patients. The aim of this study was to analyze the value of a pre-discharged determination of galectin-3 alone and with brain natriuretic peptide (BNP) in predicting mid-term outcomes in elderly patients (>70 years old) discharged after an acute decompensated HF (ADHF) episode. Methods: all elderly (≥70 years old) HF subjects discharged alive after an ADHF were enrolled. All patients underwent a determination of BNP and galectin-3, a 6-min walking test (6MWT), and an echocardiogram within 48 h of hospital discharge. Cardiac death, cardiac transplantation, and worsening heart failure requiring readmission to hospital were considered cardiovascular events. Results: 84 patients (63 males (75%), age 77.5 ± 5.9 years old) were analyzed (mean follow-up: 16.2 ± 12.3 months). During the follow-up, 45 events (53.6%) were scheduled (18 cardiac deaths, 27 re-hospitalizations for ADHF). HF patients who suffered an event demonstrated more impaired ventricular function (p = 0.04), higher value of BNP (p = 0.02), and Gal-3 at a pre-discharge evaluation (p = 0.05). By choosing adequate cut-off points (BNP ≥ 500 pg/mL and Gal-3 ≥ 17.6 ng/mL), the Kaplan–Meier curves depicted a powerful stratification using Galectin-3 > 17.6 ng/mL alone (log-rank 13.22; p = 0.0003), and by adding BNP + Gal-3, an even better result was obtained (log-rank 17.96; p < 0.00001). Conclusion: in an elderly population, by adding Gal-3 to BNP, a single pre-discharge strategy testing seemed to obtain a satisfactorily predictive value in alive HF patients discharged after an ADHF episode.

Falling asleep at the wheel among Italian professional drivers (PDs): Results from the HiRis PD study

ObjectivesA high percentage of professional drivers (PDs) often report feeling fatigue during their work, and falling asleep at the wheel (FAW) is a major contributing factor to the occurrence of near-miss or actual accidents. The aim of this study is to evaluate the prevalence of FAW among Italian PDs and the effect of fatigue on this occurrence (corrected for the main predictive factors already known).Material and MethodsWe performed a cross-sectional questionnaire survey. Data from PDs (N = 497) were used for analyses. Logistic regression analyses were performed to assess the association of reported sudden-onset sleep at the wheel with working conditions and general lifestyle factors.ResultsForty-one percent of the interviewees experienced at least 1 episode per month of sudden-onset sleep at the wheel (4.7% per week). Predictive factors of self-reported FAW were: age > 55 years old (odds ratio (OR) = 4.91, confidence interval (CI): 1.79–13.50, p < 0.01), traveling more than 40 thousand miles per year (OR = 1.86, 95% CI: 1.08–3.22, p < 0.05), body mass index ≥ 30 (OR = 2.16, 95% CI: 1.01–4.64, p < 0.05) and Chalder Fatigue Questionnaire score > 22 (OR = 3.93, 95% CI: 1.90–8.14, p < 0.01).ConclusionsThere are different work and human factors underlying FAW among PDs. The Chalder Fatigue Questionnaire might be useful in measuring fatigue in this group and in detecting PDs at high risk of experiencing FAW.