Dogs Double Risk for Distracted Driving

Distracted driving is something we usually associate with teens and their cell phones, or frenzied mothers and their minivan full of kids.  However the National Highway Safety Traffic Administration defines it as “anything that could potentially remove a driver’s eyes from the road, their hands from the steering wheel or their concentration from the task of driving.”

And that includes pets…

While most states have enacted legislation to curb the use of cell phones while driving, only one – Hawaii – has laws that specifically restrict drivers from having a pet in their lap. But a new study could be about to change all that.  The University of Alabama at Birmingham, research enrolled 2,000 drivers age 70 and older, of whom 691 had pets. Participants took a survey on driving habits, and those with pets were asked about the frequency of driving with pets. They also underwent visual sensory and higher-order visual processing testing.

The results showed that senior drivers who take a pet in the car are at increased risk for being involved in a motor vehicle collision. Both overall, and at-fault, crash rates for drivers 70 years or older were higher for those whose pet habitually rode with them.

More than half the pet owners said they took their pet with them in the car at least occasionally, usually riding on the front passenger seat or in the back seat.

“That is consistent with previous studies looking at all drivers, which indicate that slightly more than half of all drivers take a pet with them at times,” said Gerald McGwin, PhD, senior author of the study. “And it’s interesting to note that earlier surveys indicate that 83% of those surveyed agreed that an unrestrained dog was likely dangerous in a moving vehicle, yet only 16% have ever used any type of restraint on their own pet.”

The crash risk for drivers who always drove with their pets was double that of drivers who never drove with a pet, while crash rates for those who sometimes or rarely drove with pets were consistent with the rates for non-pet owners.

“This is the first study to evaluate the presence of pets in a vehicle as a potential internal distraction for elderly drivers,” said McGwin. “The increased crash rate for elderly drivers who always drive with pets is important in the context of increasing driver awareness about potentially dangerous driving habits. There is no direct evidence that driving with pets is or is not a threat to public safety, however, indirect evidence exists based on distracted driving research on texting, eating or interacting with electronics or even other passengers and there are certainly anecdotal reports in the news media of crashes and even fatalities caused by drivers distracted by a pet in the vehicle.”

The authors suggest that when confronted with an increased cognitive or physical workload while driving, elderly drivers have exhibited slower cognitive performance and delayed response times in comparison to younger age groups. Adding another distracting element, especially an animal, provides more opportunity for an older driver to respond to a driving situation in a less than satisfactory way.

Given the current debate about all types of distracted driving, further study of pet-related distracted driving behaviors among drivers, is warranted to appropriately inform the need for policy regulation on this issue.

Do you have thoughts on driving with pets?  Please let us know.

Physician, Heal Thyself!

An unwavering work ethic is a hallmark of many health professionals. But a new survey finds that when a doctor is sick, such dedication to duty can have serious consequences.

A poll of 150 attendees of an American College of Physicians meeting in 2010 revealed that more than half of resident physicians had worked with flu-like symptoms at least once in the last year and one in six reported working sick on three or more occasions during that time.

The survey conducted by researchers at the University of Chicago Medicine and Massachusetts General Hospital also asked the doctors whether they believed they’d ever directly transmitted an illness to a patient.  Shockingly, nearly 10 percent of respondents answered yes, and more than 20 percent believed other residents had passed on an illness to a patient. So much for the Hippocratic Oath and the promise to do no harm!

The results published in the Archives of Internal Medicine are further evidence of a culture of self-sacrifice long prevalent in medicine. Researchers say a physician’s sense of loyalty to already-overwhelmed peers, along with a commitment to patient care, often conflicts with an ethical stance against exposing patients and staff to an illness or compromised performance.

“Resisting the pressure to work when ill can be particularly difficult for young doctors,” said study author Anupam B. Jena, MD, PhD,. “A work-first, self-second attitude is often seen as ideal among peers, superiors and even patients.”

In the first known account of the reasons for presenteeism among doctors-in-training, more than half of respondents cited obligation to colleagues who’d be forced to cover their duties or an obligation to patient care as the top reasons for not taking a sick day.

Far fewer, a mere 12%, indicated they’d worked when ill due to concerns their colleagues would think they were “weak” and 8% came to work sick because they felt pressured to repay colleagues for coverage.

Seniority appeared to be a factor in the results. Second-year residents were more likely than first-years to select responsibility to patient care as a reason for presenteeism. Gender differences were also brought to light with female residents more likely to work sick and cite patient care as the reason. Female residents were also more likely to report fear of being perceived as weak as a motive for not taking time off.

While time away from the office carries a similar stigma in other high-pressure professions, a business  executive showing up sick to the boardroom is significantly less worrisome than a doctor with flu treating patients. An otherwise healthy doctor can often recover quickly, but an infected patient with an already-compromised immune system may not.

Clearly it’s time for doctors to stop playing superheroes.  Presenteeism needs to be addressed and eliminated. Given the intellect of most doctors it shouldn’t be too difficult for them to understand that refraining from work while ill is the most professional way to ensure responsible and safe care for patients.

A word to my doctors – if  what you’ve got is contagious or makes you so sick that your judgment is clouded – STAY HOME!

Solved! The Mystery of the Stones

Kidney stones strike an estimated 1 million Americans each year.

Those who have experienced them say it is among the most excruciating pain known to man (or woman).

Now, new research provides evidence to explain why some people are more prone to develop the condition than others. The discovery by scientists at Washington University School of Medicine in St. Louis opens the door to finding effective drug treatments and a test that could assess a person’s risk of kidney stones.

“Now, we finally have a more complete picture detailing why some people develop kidney stones and others do not,” says Jianghui Hou, PhD, assistant professor of medicine. “With this information, we can begin to think about better treatments and ways to determine a person’s risk of the condition, which typically increases with age.”

Although the research was in mice, the new findings will help scientists to understand the root causes of kidney stones in patients because their kidneys function the same way as ours.

Most kidney stones form when the urine becomes too concentrated, allowing minerals such as calcium to crystallize and stick together.  Diet plays a role – not drinking enough water or eating too much salt (which binds to calcium) increases the risk of stones.

But genes are also partly to blame. A common genetic variation called claudin-14 has recently been linked to a 65% increased risk of kidney stones.

In the new study, the researcher demonstrated how alterations in the gene’s activity influence the development of stones.  Typically, the claudin-14 gene is not active in the kidney. Its expression is dampened by two snippets of RNA, that essentially silence the gene.  When claudin-14 is idled, the kidney’s filtering system works like it’s supposed to. Essential minerals in the blood pass through the kidneys and are reabsorbed back into the blood, where they are transported to cells to carry out basic functions of life.

But when people eat a diet high in calcium or salt and don’t drink enough water, the small RNA molecules release their hold on claudin-14 and the subsequent increase in the gene’s activity prevents calcium from re-entering the blood.  Without a way back to the bloodstream, excess calcium passes into the urine. Too much calcium in the urine leads to the development of stones in the kidneys or bladder.

Then when a large stone gets stuck in the bladder, ureter or urethra the flow of urine is blocked and the characteristic intense pain, that can reduce even the most mild-mannered man to a cursing, foul-mouthed monster, develops.

People with the common, genetic variation in claudin-14 lose the ability to regulate the gene’s activity, increasing the risk of kidney stones.

The results of this research lead to the hope that drugs that will keep the activity of claudin-14 in check can be developed.  Additionally, it may be possible to develop a diagnostic test to measure levels of the claudin-14 protein excreted in urine. Elevated levels would indicate an increased risk of stones, and people could take steps to prevent stones by modifying their diet.

“Many genes likely play a role in the formation of kidney stones,” Hou says. “But this study gives us a better idea of the way one of the major players work. Now that we understand the physiology of the condition, we can start to think about better treatments or even ways to prevent stones from developing in the first place.”

For the million or so sufferers and their loved ones we guess that day can’t come soon enough.