Exploring the Factors Associated with 12-Month Non-Return to Work among Motorcyclists Involved in Road Accidents

Introduction: Motorcyclists bear a disproportionate burden of morbidity and mortality from road accidents. In addition, the consequences of these accidents affect the ability of victims to return to work. This study aimed to determine the prevalence and factors associated with non-return to work among surviving motorcyclists involved in road accidents 12 months after the event. Materials and Methods: It was a cross-sectional study conducted using data from a cohort of motorcyclists involved in accidents and recruited in five hospitals in Benin from July 2019 to January 2020. The dependent variable was non-return to work 12 months after the accident (yes vs no). The independent variables were categorized into two groups: baseline and 12-month follow-up variables. Logistic regression was used to determine the factors associated with non-return to work at 12 months among the participants. Results: Among the 362 participants, 55 (15.19%, 95% CI = 11.84 - 19.29) had not returned to work 12 months after the accident. Risk factors for non-return to work identified were: smoking (aOR = 4.41, 95% CI = 1.44 - 13.56, p = 0.010), hospitalization (aOR = 2.87, 95% CI = 1.14 - 7.24, p Conclusion: The prevalence of non-return to work at 12 months was high among surviving motorcyclists involved in road accidents in Benin. Integrated support for patients based on identified risk factors should effectively improve their return to work.

Excessive Drowsiness among Truck Drivers in Benin in 2023: Associated Factors and Risk of Crashes Occurrence

Introduction: Over-drowsiness is a condition with serious consequences, including road accidents. The condition, however, is often ignored both by carers as well as victims themselves. The aim of the present study was to investigate the factors associated with excessive drowsiness in Cotonou, Benin 2023, along with its influence on the occurrence of crashes among truck drivers. Methods: This was a descriptive and analytical cross-sectional study, held from March 13 to April 10, 2023, focusing on large truck drivers over 18 years of age, selected by convenience from parking lots in and around the city of Cotonou. Data collected using questionnaires on socio-demographic and behavioral factors, sleeping habits and working conditions were processed using Stata 15.0 software. Excessive drowsiness was defined by a score above 10 on the Epworth scale. Associated factors were found by multiple logistic regression, at a threshold of 0.05. Results: Altogether 304 drivers, all male and aged 35.98 ± 8.42 years, were surveyed. The prevalence of excessive drowsiness was 29.2%. The associated factors identified were not practicing sport OR = 2.27, CI95% = [1.33;3.86], p = 0,002;sleep duration per working day OR = 1.82;CI95% = [1.06;3.11], p = 0,027 and average distance travelled per day OR = 3.40;CI95% = [1.53;7.56], p = 0,003. Excessive drowsiness was associated with a 1.73-fold increased risk of road accidents (CI95% [1.04;2.87];p = 0.03). Conclusion: Communicating excessive drowsiness and its associated factors to all the stakeholders in the haulage chain is essential to help prevent road accidents.

Key Road Injury Prevention Interventions and Their Effectiveness in Africa: Conclusions and What Can Be Done Better

Introduction: This study aimed to identify road safety interventions implemented in Africa and to analyze their effectiveness in reducing road crashes, injuries, disabilities and deaths. Materials and Methods: This is a systematic review including articles relating to the evaluation of road safety interventions implemented in Africa that were searched on electronic databases: PubMed, Scopus, Lissa, Google Scholar, and African Journals Online. Selection of articles and data extraction was conducted by two pairs of reviewers. Data quality was checked according to the type of study. A qualitative analysis of the data was carried out and a narrative approach was adopted to describe and synthesize the results. Results: A total of twenty-nine articles were selected including one cross-sectional study, seven time series, twenty-one quasi-experimental studies of which six randomised and fifteen non-randomised studies. The type of interventions evaluated was aimed at all types of users and was based on different interventions such as institutional strengthening, law enforcement, awareness raising, training or user education, vehicle maintenance and infrastructure improvements. For fourteen studies all the expected indicators had changed favourably and for twelve the indicators had partially changed. The studies that showed significant change were institutional strengthening, law enforcement, awareness raising, training, or user education interventions, development of Uber transport services, distribution of equipment, and a combination of interventions. Conclusion: This situation is indicative of insufficient policy investment in research but also in the field of road safety in general.

Prevalence and Factors Associated with Psychoactive Substance Misuse among Heavy Goods Vehicle Drivers in Cotonou, Benin

Introduction: In Benin, Heavy Goods Vehicle (HGV) drivers play an essential role in the logistics chain, facilitating the transportation of goods within the country or between other countries in the sub-region. HGV drivers are professionals who experience adverse working conditions, exposing them to risky behaviours, including Psychoactive Substance (PAS) misuse, leading to particularly severe road accidents. This study aimed to determine the prevalence of PAS misuse among HGV drivers and identify associated factors in Cotonou, Benin. Materials and Methods: We conducted a cross-sectional survey involving HGV drivers at parking areas in Cotonou from 26 March to 10 April 2023. The dependent variable was the PAS misuse by HGV drivers, and the independent variables were related to their socio-demographic characteristics, health status and lifestyle habits, and professional characteristics. Data analysis involved determining the prevalence of PAS misuse with a 95% Confidence Interval (95% CI). Subsequently, we identified factors associated with PAS misuse among the participants using multivariate logistic regression. We presented the final regression results as adjusted odds ratios (aOR) with 95% CI. Results: The study included 425 HGV drivers. Among them, 53 (12.47%, 95% CI = 9.64 - 15.98) were misusing PAS. Compared to drivers aged 35 and older, those aged under 25 (aOR = 10.67, 95% CI = 3.56 - 32.03) and those aged 25 to 34 (aOR = 3.47, 95% CI = 1.37 - 8.82) had higher odds of PAS misuse. Drivers with a primary education were less likely (aOR = 0.43, 95% CI = 0.19 - 0.97) to misuse PAS than those with no formal education. Drivers suffering from cardiovascular diseases were also three times more likely (aOR = 3.08, 95% CI = 1.08 - 8.81) to misuse PAS than others. The odds of PAS misuse were also higher among drivers who reported taking breaks than those claiming not to (aOR = 3.11, 95% CI = 1.57 - 6.18). Conclusion: Driving under the influence of PAS is a risk factor for road accidents, associated with other factors highlighted in this study. Addressing these factors in prevention strategies through integrated approaches could lead to more effective results.

Disability to Admit as a Change of Life after a Road Crash: Estimates and Related Factors in Benin for Prevention

Background: Disability is an underestimated issue in public health, with road crashes as leading cause. In Africa, motorcyclists disproportionately bear the burden of road crash injuries, including disability. To contribute to decision-making for disability prevention, this study aims to determine the prevalence and factors associated with disability at 12 months among motorcyclists involved in road crashes in Benin. Methods: This is a prospective, cross-sectional, analytical study based on 12-month follow-up data from a cohort of road crash victims set up in five hospitals in Benin. Data were collected from November 2020 to January 2021. Sample used for this analysis size was 297 motorcyclists. Disability was assessed using the Washington Group on Disabilities Statistics question set. Logistic regression analysis was used to identify risk factors for disability in victims 12 months after the crash. Results: The prevalence of disability was 12.5% 95% CI (9.2 - 16.7). Disability occurrence was associated with being over 45 years old (OR = 3.1;95% CI = 1.5 - 6.6), severity of initial injury (OR = 3.3;95% CI = 1.5 - 7.3) and hospitalisation of the victim (OR = 6.9;95% CI = 2.0 - 24). Conclusion: Age over 45 years, severity of initial injuries and hospitalisation of the victim were risk factors for the occurrence of disability among motorcyclists who were victims of road crashes in Benin. User awareness, law enforcement, holistic and early management of road crash victims could contribute to reducing the prevalence of disability among victims in Benin.

A scoring system for predicting the risk of breast cancer-related lymphedema

Objective:We aimed to establish a scoring system to predict the risk of breast cancer-related lymphedema.Methods:From April 2017 to December 2018,533 patients who previously underwent surgery for breast cancer were enrolled in this cross-sectional study.Univariate analysis was performed to explore and define the risk factors.A scoring system was then established on the basis of odds ratio values in the regression analysis.Results:The additive scoring system values ranged from 6 to 22.The receiver operating characteristic(ROC)curve of this scoring system showed a sensitivity and specificity of 83.3%and 57.3%,respectively,to predict the risk of lymphedema at a cut-off of 15.5 points;the area under the curve was 0.736(95%confidence interval:0.662-0.811),with x2=5.134(P=0274)for the Hosmer-Lemeshow test.Conclusions:The predictive efficiency and accuracy of the scoring system were acceptable,and the system could be used to predict and screen groups at high risk for breast cancer-related lymphedema.

Clinical Predictors for Diagnosing Pandemic (H1N1) 2009 and Seasonal Influenza (H3N2) in Fever Clinics in Beijing,China

Objective Symptomatic predictors of influenza could assess risks and improve decisions about isolation and outpatient treatment. To develop such predictors, we undertook a prospective analysis of pandemic （HIN1） 2009 and seasonal influenza （H3N2） in patients attending fever clinics. Methods From 1 May 2009 to 1 January 2010, all adult patients admitted to fever clinics for suspected influenza, confirmed by real time RT-PCR, were enrolled. Predictors of influenza virus infection were selected with logistic regression models. Measures of sensitivity, specificity, positive and negative likelihood ratios （LRs） were calculated to identify the best predictors. Results The clinical features and routine blood test results of influenza （H1N1） 2009 and seasonal influenza were similar. The positive and negative LRs of current US CDC influenza-like illness （ILl） criteria were modest in predicting influenza infection. Our modified clinic predictors improved the ability of the positive and negative LRs to recognize pandemic （HIN1） 2009 and seasonal influenza. The revised criteria are： fever ~ 38 ~C accompanied by at least one of the following--cough, arthralgia or relative iymphopenia. Conclusion Patients with symptoms and signs that meet the new criteria are likely to have influenza and timely antiviral therapy may be appropriate. In addition, physicians should ascertain if influenza is circulating within the community or if there is a contact history of influenza and combine this information with the newly developed criteria to clinically diagnose influenza.

Comparison of cancer incidence and mortality in three GDP per capita levels in China, 2013

Objective：In this research,the patterns of cancer incidence and mortality in areas with different gross domestic product per capita（GDPPC）levels in China were explored,using data from population-based cancer registries in 2013,collected by the National Central Cancer Registry（NCCR）.Methods：Data from 255 cancer registries were qualified and included in this analysis.Based on the GDPPC data of 2014,cities/counties were divided into 3 levels：high-,middle-and low-GDPPC areas,with 40,000 and 80,000 RMB per year as cut points.We calculated cancer incidences and mortalities in these three levels,stratified by gender and age group.The national population of the Fifth Census in 2000 and Segi’s population were applied for age-standardized rates.Results：The crude incidence and mortality rates as well as age-standardized incidence rate（ASIR）showed positive associations with GDPPC level.The age-standardized mortality rate（ASMR）nevertheless showed a negative association with GDPPC level.The ASMR in high-,middle-and low-GDPPC areas was 103.12/100,000,112.49/100,000 and 117.43/100,000,respectively.Lung cancer was by far the most common cancer in all three GDPPC levels.It was also the leading cause of cancer death,regardless of gender and GDPPC level.Negative associations with GDPPC level were found for the ASIRs of lung,stomach,esophageal and liver cancer,whereas colorectal and breast cancer showed positive associations.Except for breast cancer,the ASMRs of the other five cancers were always higher in middle-and low-GDPPC areas than in high-GDPPC areas.Conclusions：The economic development is one of the main factors of the heavy cancer burden on Chinese population.It would be reasonable to implement cancer control strategies referring to the local GDPPC level.

Alcohol, Tobacco and Tramadol Daily Consumption and Road Traffic Crashes among Motorcycle Taxi Drivers in Cotonou (Benin)

Background: In Benin, motorcycle taxi drivers make up a significant portion of road transport. The use of psychoactive substances, a behavior recognized as being at risk of road crashes, is frequent in this group. This study aimed to analyze the association between the consumption of psychoactive substances and the occurrence of road crashes among motorcycle taxi drivers. Methods: This was a cross-sectional study involving 430 motorcycle taxi drivers selected from motorcycle taxi stands in Cotonou (Benin) using a two-stage cluster sampling technique. An interview with a structured questionnaire was used to collect data, which took place in March and April 2019. Alcohol, tramadol, and tobacco were the psychoactive substances considered in this study and their daily use was investigated. A binary logistic regression was used for the analysis. Results: Among the motorcycle taxi drivers surveyed, 27.79% (95% CI = 23.71 - 32.25) were involved in a road crash. The prevalence of psychoactive substances daily use was: 30.41% (95% CI = 26.17 - 35.00) for alcohol, 28.50% (95% CI = 24.37 - 33.02) for tramadol and 4.03% (95% CI = 2.51 - 6.42) for tobacco. Alcohol daily consumption (AOR = 2.09, 95% CI = 1.27 - 3.45, p = 0.004) was associated with a significant risk of road crashes. Conclusion: Interventions aiming to reduce psychoactive substances use should, therefore, be included in road safety policies, especially for this group.

Calcium dobesilate for diabetic retinopathy: a systematic review and meta-analysis

Many randomized clinical controlled trials have confirmed the efficacy and safety of calcium dobesilate in treating diabetic retinopathy(DR).This systematic review critically evaluated the evidence that links calcium dobesilate to DR.In this fixed-effects meta-analysis,a total of 221 pertinent English-language articles published between January 1975 and October 2013 were identified.Systematic searches of PUBMED,Springer Link and the Cochrane Clinical Trials Database were conducted using the keywords "diabetic retinopathy" and "calcium dobesilate".The extracted information included the study design,inclusion and exclusion criteria,setting,sample size,participant mean age,treatment regime,mean change in best corrected visual acuity,laboratory parameters,capillary fragility,intraocular pressure and fundus manifestations based on the findings of fluorescent angiography.The summary statistics indicated that calcium dobesilate was significantly associated with improving retinal microaneurysms(RR: 0.62,95%CI: 0.42?0.90,P=0.01),retinalhemorrhages(RR: 0.39,95% CI: 0.17?0.88,P=0.02); exudates(RR: 0.31,95% CI: 0.12?0.81,P=0.02),reduction of whole blood viscosity(MD: ?0.57 CP,95% CI: ?0.75 to ?0.38,P<0.001),plasma viscosity(MD: ?0.36 CP,95% CI: ?0.63 to ?0.09,P=0.01) and blood cholesterol(MD: ?0.48 mg m L?1,95% CI: ?0.64?0.33,P<0.00001).Intraocular pressure was also significantly reduced(MD: ?5.59 mm Hg,95% CI: ?6.69 to ?4.50,P<0.00001).The results indicate that calcium dobesilate effectively treats DR at the systematic and local ocular levels.

Chinese registry of rheumatoid arthritis: IV. Correlation and consistency of rheumatoid arthritis disease activity indices in China

Background:Disease activity indices(DAIs)including disease activity score 28(DAS28),simplified disease activity index(SDAI),and clinical disease activity index(CDAI)have been widely used in clinical practice and research studies of rheumatoid arthritis(RA).The objective of our study was to evaluate the correlation and concordance among different DAIs in Chinese patients with RA.Methods:A cross-sectional study,including patients enrolled in the Chinese registry of rheumatoid arthritis from November 2016 to August 2018,was conducted.The correlations were evaluated using Spearman correlation coefficient and concordance with Bland-Altman plots,quadratic weighted kappa,and discordance rates in the crosstab.For other indices,the optimal cutoff points corresponding to SDAI remission were explored through receiver operating characteristic curve analysis.Results:A total of 30,501 patients were included,of whom 80.46%were women.Most individuals were with moderate disease activity or high disease activity.High correlations among DAS28-erythrocyte sedimentation rate(ESR)and DAS28-C-reactive protein(CRP),SDAI and CDAI were observed.Similarly,the weighted kappa value among the indices was high.In Bland-Altman plots,a positive difference between DAS28-ESR and DAS28-CRP was observed,with an absolute difference of>1.2 in 3079(10.09%)patients.In crosstab,approximately 30%of the patients were classified into different groups.Concordance values between SDAI remission and the optimal cutoff points of DAS28-ESR,DAS28-CRP,and CDAI were 3.06,2.37,and 3.20,respectively.Conclusions:Although DAIs had high correlations and weighted kappa values,the discordance between DAIs was significant in Chinese patients with RA.The four DAIs are not interchangeable.

Chinese registry of rheumatoid arthritis(CREDIT)V:sex impacts rheumatoid arthritis in Chinese patients

Background: The impact of sex on the clinical manifestations of rheumatoid arthritis (RA) were diversely reported in the literature. The Chinese Registry of rhEumatoiD arthrITis provides a platform for the investigation of this issue in Chinese patients.Methods: Demographic and clinical parameters were collected from all enrolled patients with RA and from patients with early RA (disease duration ≤6 months). The differences in data regarding disease activity, comorbidities, and medications for RA were compared between men and women. The proportions of patients who achieved remission and low disease activity were compared at enrollment and during 3-, 6-, and 12-month follow-up visits.Results: A total of 11,564 patients were enrolled, 83.6% of whom were female. In all the enrolled patients and patients with early RA, C-reactive protein (CRP, 12.0vs. 6.7 mg/L), pain visual analogue scale (4.8vs. 4.5), patient’s and physician’s global assessment (4.9vs. 4.5 and 4.9vs. 4.5), 28-joint disease activity score using DAS28-CRP (4.3vs. 4.0) simplified disease activity index (21.9vs. 19.9), and clinical disease activity index (19.3vs. 18.0) were significantly higher in men than in women. Additionally, the swollen joint count/tender joint count and DAS28 using erythrocyte sedimentation rate were higher in male patients than in female patients with early RA. More female patients with early RA reached the treatment target at baseline than male patients (23.4%vs. 18.2%, assessed by CDAI). At 3 months, 6 months, and 12 months, the proportion of remission and treatment target achievement was similar in both sexes. Coronary artery disease (CAD) and stroke were more frequent in men than in women.Conclusions: In Chinese patients with RA, men were found to have more active disease, as well as more cases of CAD and stroke. Therefore, sex should be carefully considered during the personalization of RA treatment.

Clinical efficacy of tacrolimus in systemic lupus erythematosus with various manifestations:a real-world study

To the Editor:Systemic lupus erythematosus(SLE)is an autoimmune disease involving multiple systems.In recent years,the therapeutic treat-to-target(T2T)strategy was recommended for SLE.^([1])The immunosuppressive drugs are the standard of care in SLE treatment.Tacrolimus was one of the calcineurin inhibitors which was recommended in the 2019 update of the Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association recommendations for the management of lupus nephritis(LN)^([2]).