Aberrant Behaviors of Heavy Vehicle Drivers Carrying Hazardous Materials at an International Border in Iran

Background: Most road collisions are directly attributed to human factors. Since aberrant behaviors of drivers play a pivotal role in the occurrence of road accidents, it is worth studying driver behaviors in a riskier situation of carrying hazardous materials. This study aimed to evaluate the behaviors of the drivers carrying hazardous materials at the international border of Bashmaq-Marivan, Iran. Methods: This descriptive-analytical study was conducted on 250 Iranian drivers carrying hazardous materials at the international border of Bashmaq-Marivan. The participants were included taking a census. Data were collected using the Manchester Driver Behavior Questionnaire (MDBQ). Data analysis was performed by SPSS v 16. The p-value of less than 0.05 was considered statistically significant. Results: The drivers carrying inflammable liquids had more lapses compared to those carrying inflammable gases. The drivers with less driving experience and higher driving speed had more errors, as well as aggressive and ordinary violations. Higher rates of aggressive violations and errors were detected in young drivers, while the drivers with higher rates of accidents had comparatively more lapses and ordinary violation. Conclusion: Considering the effects of age, driving experience, high speed, and accident experience on aberrant behaviors in driving, it is recommended that public training targeting specific groups be implemented regarding the legal constraints of driving.

Long-term melatonin treatment for the sleep problems and aberrant behaviors of children with neurodevelopmental disorders

Background Clinical evidence is required about the long-term efficacy and safety of melatonin treatment for sleep problems in children with neurodevelopmental disorders (NDDs) who underwent adequate sleep hygiene interventions. Methods We conducted a 26-week, multicenter, collaborative, uncontrolled, open-label, phase III clinical trial of melatonin granules in children 6 to 15 years of age who had NDDs and sleep problems. The study consisted of the 2-week screening phase, the 26-week medication phases I and II, and the 2-week follow-up phase. Children received 1, 2, or 4 mg melatonin granules orally in the medication phases. Variables of sleep status including sleep onset latency (SOL), aberrant behaviors listed on the Aberrant Behavior Check List-Japanese version (ABC-J), and safety were examined. The primary endpoint was SOL in the medication phase I. Results Between June 2016 and July 2018, 99 children (80 males and 19 females, 10.4 years in mean age) were enrolled at 17 medical institutions in Japan—74, 60, 22, 9, 6, and 1 of whom had autism spectrum disorder, attention-deficit/hyperactivity disorder, intellectual disabilities, motor disorders, specific learning disorder, and communication disorders, respectively, at baseline. Fifteen children received the maximal dose of 4 mg among the prespecified dose levels. SOL recorded with the electronic sleep diary shortened significantly (mean ± standard deviation [SD], − 36.7 ± 46.1 min; 95% confidence interval [CI], − 45.9 to − 27.5; P < 0.0001) in the medication phase I from baseline, and the SOL-shortening effect of melatonin persisted in the medication phase II and the follow-up phase. Temper upon wakening and sleepiness after awakening improved significantly (P < 0.0001 each) in the medication phase I from baseline and persisted in the follow-up phase. The following subscales of the ABC-J improved significantly: stereotypic behavior (P = 0.0322) in the medication phase I; and irritability, hyperactivity, and inappropriate speech (P < 0.0001) in the medication phase II. Treatment-emergent adverse events did not occur subsequent to week 16 after medication onset, and NDDs did not deteriorate in the follow-up phase. Conclusions Long-term melatonin treatment in combination with adequate sleep hygiene interventions may afford clinical benefits to children with NDDs and potentially elevates their well-being. Trial registration ClinicalTrils.gov, NCT02757066. Registered April 27, 2016.

Re-assessing the Validity of the Opioid Risk Tool in a Tertiary Academic Pain Management Center Population

ObjectiveTo analyze the validity of the Opioid Risk Tool (ORT) in a large. diverse population.DesignA cross-sectional descriptive study.SettingAcademic tertiary pain management center.SubjectsA total of 225 consecutive new patients, aged 18 years or older.MethodsData collection included demographics, ORT scores, aberrant behaviors, pain intensity scores, opioid type and dose, smoking status, employment, and marital status.ResultsIn this population, we were not able to replicate the findings of the initial ORT study. Self-report was no better than chance in predicting those who would have an opioid aberrant behavior. The ORT risk variables did not predict aberrant behaviors in either gender group. There was significant disparity in the scores between self-reported ORT and the ORT supplemented with medical record data (enhanced ORT). Using the enhanced ORT, high-risk patients were 2.5 times more likely to have an aberrant behavior than the low-risk group. The only risk variable associated with aberrant behavior was personal history of prescription drug misuse.ConclusionsThe self-report ORT was not a valid test for the prediction of future aberrant behaviors in this academic pain management population. The original risk categories (low, medium, high) were not supported in the either the self-reported version or the enhanced version; however, the enhanced data were able to differentiate between high- and low-risk patients. Unfortunately, without technological automation, the enhanced ORT suffers from practical limitations. The self-report ORT may not be a valid tool in current pain populations; however, modification into a binary (high/low) score system needs further study.