Study highlights shift in road safety attitudes

Motorists today think improving main roads is the best way to prevent accidents, according to new AA research. But this viewpoint has changed significantly since the study was first carried out 20 years ago.

According to the AA, 72 per cent of its members believe that improving main roads would make the biggest contribution to reducing road deaths and injuries.

This is almost a complete reversal of opinion compared to 20 years ago, when AA members voted it as only the 10th most important factor in improving road safety.

Stronger driver and pedestrian training was voted as the second priority, up from 9th position in 1993.

A total drink-drive ban came in third, down from pole position 20 years ago.

Stronger driver and pedestrian training

More severe laws and penalties

More cycle paths and priority for cyclists

Although some priorities have attracted consistently strong support, such as random breath testing, others have moved up or down as the years have passed.

This illustrates how, over time, public opinion can shift when it comes to road safety issues.

Take the law requiring drivers and front seat passengers in cars to wear seat belts, for example.

This was introduced in 1983 and at the time a large minority of motorists strongly opposed this "interference" from the law.

In fact only 40 per cent of drivers and front seat passengers wore seat belts before its introduction, according to road safety group the Road Safety Observatory.

However, there was an immediate 25 per cent reduction in driver fatalities and a 29 per cent reduction in fatal injuries among front seat passengers, its statistics show.

It was estimated that the seat belt law saved the lives of 241 drivers and 147 front passengers in 1983 alone.

And nowadays, you would expect the majority of drivers to agree this law was a reasonable addition to our legal system.

The use of mobile phones is another example of how attitudes can shift over time when it comes to road safety.

Using a handheld mobile phone while driving was made illegal in December 2003.

The effect of talking on a phone while driving has been shown to be worse than drinking certain levels of alcohol, according to road safety charity Brake.

Drivers using phones have slower reaction times and have greater difficulty controlling speed and lane position, it says, with those who talk on phone four times more likely to be in a crash that causes injury.

And according to research by insurer LV=, 82 per cent of motorists agree and now think it is unacceptable to use a handheld phone when driving.

Ellen Booth is senior campaigns officer at Brake and says changing driver attitudes and behaviour is the most important thing we can do to make our roads safer.

Booth says: "This is tough work, but it can be achieved through a combination of public education and changes in the law.

"Bringing in new laws, or toughening up old ones, can help to normalise safer driving behaviour and stigmatise risky behaviour previously seen as acceptable by the public, such as drink driving or not wearing a seatbelt.

"The smoking ban is a great example of how a simple change in the law can drive public opinion and behaviour, without requiring a lot of enforcement."

So in 10 or 20 years from now, will we look back at any of our current driving behaviour and wonder how this was ever not illegal?

Brake campaigns for a zero drink drive limit, and should this ever be brought into law, could this be one such example?

Booth adds: "We campaign for a zero tolerance drink drive limit of 20mg alcohol per 100ml blood, which means you couldn’t have one pint and drive.”

Currently the UK alcohol limit for drivers is 80mg of alcohol per 100ml of blood.

She adds: "The current limit sends out the wrong message, that it is safe to drink one or two, and encourages drivers to gamble with their safety, and guess whether they are over the legal limit.

"There is no way to calculate if you are legal to drive from the number of units you’ve had and evidence is clear that even very small amounts of alcohol significantly impair driving.

"Simply lowering the limit would have a big impact on public understanding of the risks involved."

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Shift work and the assessment and management of shift work disorder (SWD)

Available online 2 May 2012

In Press, Corrected Proof — Note to users

a Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado at Boulder, 1725 Pleasant Street, Boulder, CO 80309, USAb SleepMed Incorporated, SleepMed of South Carolina, 700 Gervais Street, Suite #200, Columbia, SC 29201, USAc School of Medicine, University of South Carolina, USAd Sleep Disorders Service and Research Center, Rush University Medical Center, Johnston R. Bowman Health Center, 710 S. Paulina Street, 6 South JRB, Chicago, IL 60612, USAReceived 5 July 2011. Revised 10 February 2012. Accepted 13 February 2012. Available online 2 May 2012.View full text Nearly 20% of the labor force worldwide, work shifts that include work hours outside 07:00 h to 18:00 h. Shift work is common in many occupations that directly affect the health and safety of others (e.g., protective services, transportation, healthcare), whereas quality of life, health, and safety during shift work and the commute home can affect workers in any field.

Increasing evidence indicates that shift-work schedules negatively influence worker physiology, health, and safety. Shift work disrupts circadian sleep and alerting cycles, resulting in disturbed daytime sleep and excessive sleepiness during the work shift. Moreover, shift workers are at risk for shift work disorder (SWD). This review focuses on shift work and the assessment and management of sleepiness and sleep disruption associated with shift work schedules and SWD. Management strategies include approaches to promote sleep, wakefulness, and adaptation of the circadian clock to the imposed work schedule. Additional studies are needed to further our understanding of the mechanisms underlying the health risks of shift work, understanding which shift workers are at most risk of SWD, to investigate treatment options that address the health and safety burdens associated with shift work and SWD, and to further develop and assess the comparative effectiveness of countermeasures and treatment options.

prs.rt("abs_end");Shift work; Shift work disorder; Circadian rhythm; Circadian adaptation; Circadian misalignment; Homeostatic sleep drive; Good sleep behavior; Sleep duration; Caffeine; Naps; Melatonin; Hypnotics; Armodafinil; Modafinil

Figures and tables from this article:

Fig. 1. Occupations with a large proportion of shift workers (>20%).8

View Within ArticleFig. 2. Characterization of brain arousal across the 24-h day in a typical day worker and a night shift worker. Wakefulness and sleep are dependent upon the interplay between the circadian alerting signal and the homeostatic sleep drive in day- and night-shift workers. In a typical day worker (A), the sleep and circadian systems interact in such a way that alert wakefulness is promoted during the day and sleep is promoted at night. A circadian arousal signal increases across the day to counteract the buildup of sleep pressure that occurs with time awake. In a non-adapted night-shift worker (B), the circadian arousal signal increases across the day when the shift worker is attempting to sleep, resulting in short sleep duration. During the night shift, the circadian system and sleep pressure promote sleep, leading to excessive sleepiness during the work shift. Modified from Drake, 2010.128

View Within ArticleFig. 3. Baseline untreated. In the modafinil study (n = 182) (data on file)69 and armodafinil study (n = 216) (data on file, Cephalon),70 mean nighttime sleep latencies at baseline in untreated patients with shift work disorder (SWD) decreased over the course of a laboratory night shift. Sleep latency data from healthy control groups in three relatively small (n = 15–30), simulated, night-shift studies are also depicted (Study 1: Walsh et al., 1988; Study 2: Walsh et al., 1991; Study 3: Muehlbach and Walsh, 1995 [74], [75] and [76]) showing that healthy controls are more alert than patients with shift work disorder (A). A worsening of subjective sleepiness, as measured by the Karolinska sleepiness scale (KSS), also was seen in the modafinil and armodafinil studies in patients with SWD (B). Modafinil study: At the final visit of the modafinil study (n = 182), multiple sleep latency test (MSLT) scores for the modafinil group had significantly improved from baseline, compared with MSLT scores for the placebo group, at 02:00 h and 04:00 h but not at 06:00 h or 08:00 h (C). KSS scores in the modafinil group were also significantly improved at each time point from midnight to 05:00 h and also at 07:00 h, compared with scores in the placebo group (D).69 Panel C adapted with permission from Czeisler et al., 2005.69 Armodafinil study: At the final visit of the armodafinil study (n = 216), MSLT scores for the armodafinil group were significantly improved, compared with MSLT scores for the placebo group, at all time points measured (E). KSS scores also were significantly improved at each time point from 23:55 h to 05:55 h in the armodafinil group (F).70 Panels E and F reprinted with permission from Czeisler et al., 2009.70*p < 0.001; †p < 0.05, change from baseline vs. placebo. Higher KSS scores indicate greater sleepiness.

View Within ArticleTable 1. Diagnostic and supportive criteria for shift work disorder.13

View Within ArticleTable 2. Clinical guidelines for assessment and management of shift work disorder (SWD).73

ESS, Epworth sleepiness scale; SWD, shift work disorder; KSS, Karolinska sleepiness scale. Modified with permission from Drake and Wright.73

View Within ArticleCopyright © 2012 Elsevier Ltd. All rights reserved.

prs.rt('data_end');

View the original article here

Shift work and the assessment and management of shift work disorder (SWD)

Available online 2 May 2012

In Press, Corrected Proof — Note to users

a Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado at Boulder, 1725 Pleasant Street, Boulder, CO 80309, USAb SleepMed Incorporated, SleepMed of South Carolina, 700 Gervais Street, Suite #200, Columbia, SC 29201, USAc School of Medicine, University of South Carolina, USAd Sleep Disorders Service and Research Center, Rush University Medical Center, Johnston R. Bowman Health Center, 710 S. Paulina Street, 6 South JRB, Chicago, IL 60612, USAReceived 5 July 2011. Revised 10 February 2012. Accepted 13 February 2012. Available online 2 May 2012.View full text Nearly 20% of the labor force worldwide, work shifts that include work hours outside 07:00 h to 18:00 h. Shift work is common in many occupations that directly affect the health and safety of others (e.g., protective services, transportation, healthcare), whereas quality of life, health, and safety during shift work and the commute home can affect workers in any field.

Increasing evidence indicates that shift-work schedules negatively influence worker physiology, health, and safety. Shift work disrupts circadian sleep and alerting cycles, resulting in disturbed daytime sleep and excessive sleepiness during the work shift. Moreover, shift workers are at risk for shift work disorder (SWD). This review focuses on shift work and the assessment and management of sleepiness and sleep disruption associated with shift work schedules and SWD. Management strategies include approaches to promote sleep, wakefulness, and adaptation of the circadian clock to the imposed work schedule. Additional studies are needed to further our understanding of the mechanisms underlying the health risks of shift work, understanding which shift workers are at most risk of SWD, to investigate treatment options that address the health and safety burdens associated with shift work and SWD, and to further develop and assess the comparative effectiveness of countermeasures and treatment options.

prs.rt("abs_end");Shift work; Shift work disorder; Circadian rhythm; Circadian adaptation; Circadian misalignment; Homeostatic sleep drive; Good sleep behavior; Sleep duration; Caffeine; Naps; Melatonin; Hypnotics; Armodafinil; Modafinil

Figures and tables from this article:

Fig. 1. Occupations with a large proportion of shift workers (>20%).8

View Within ArticleFig. 2. Characterization of brain arousal across the 24-h day in a typical day worker and a night shift worker. Wakefulness and sleep are dependent upon the interplay between the circadian alerting signal and the homeostatic sleep drive in day- and night-shift workers. In a typical day worker (A), the sleep and circadian systems interact in such a way that alert wakefulness is promoted during the day and sleep is promoted at night. A circadian arousal signal increases across the day to counteract the buildup of sleep pressure that occurs with time awake. In a non-adapted night-shift worker (B), the circadian arousal signal increases across the day when the shift worker is attempting to sleep, resulting in short sleep duration. During the night shift, the circadian system and sleep pressure promote sleep, leading to excessive sleepiness during the work shift. Modified from Drake, 2010.128

View Within ArticleFig. 3. Baseline untreated. In the modafinil study (n = 182) (data on file)69 and armodafinil study (n = 216) (data on file, Cephalon),70 mean nighttime sleep latencies at baseline in untreated patients with shift work disorder (SWD) decreased over the course of a laboratory night shift. Sleep latency data from healthy control groups in three relatively small (n = 15–30), simulated, night-shift studies are also depicted (Study 1: Walsh et al., 1988; Study 2: Walsh et al., 1991; Study 3: Muehlbach and Walsh, 1995 [74], [75] and [76]) showing that healthy controls are more alert than patients with shift work disorder (A). A worsening of subjective sleepiness, as measured by the Karolinska sleepiness scale (KSS), also was seen in the modafinil and armodafinil studies in patients with SWD (B). Modafinil study: At the final visit of the modafinil study (n = 182), multiple sleep latency test (MSLT) scores for the modafinil group had significantly improved from baseline, compared with MSLT scores for the placebo group, at 02:00 h and 04:00 h but not at 06:00 h or 08:00 h (C). KSS scores in the modafinil group were also significantly improved at each time point from midnight to 05:00 h and also at 07:00 h, compared with scores in the placebo group (D).69 Panel C adapted with permission from Czeisler et al., 2005.69 Armodafinil study: At the final visit of the armodafinil study (n = 216), MSLT scores for the armodafinil group were significantly improved, compared with MSLT scores for the placebo group, at all time points measured (E). KSS scores also were significantly improved at each time point from 23:55 h to 05:55 h in the armodafinil group (F).70 Panels E and F reprinted with permission from Czeisler et al., 2009.70*p < 0.001; †p < 0.05, change from baseline vs. placebo. Higher KSS scores indicate greater sleepiness.

View Within ArticleTable 1. Diagnostic and supportive criteria for shift work disorder.13

View Within ArticleTable 2. Clinical guidelines for assessment and management of shift work disorder (SWD).73

ESS, Epworth sleepiness scale; SWD, shift work disorder; KSS, Karolinska sleepiness scale. Modified with permission from Drake and Wright.73

View Within ArticleCopyright © 2012 Elsevier Ltd. All rights reserved.

prs.rt('data_end');

View the original article here