Health status and motor vehicle crashes

Article Abstract:

In the January 3, 1991 issue of The New England Journal of Medicine, researchers present the results of a study evaluating the contribution of controlled epilepsy and diabetes mellitus to the risk of automobile accidents. The study reports only a modest increase in the overall risk of accidents among epileptic and diabetic drivers, and suggests that further regulation of the driving privileges of patients with these disorders is unwarranted. The study leaves important questions unanswered, however. There is no determination whether, for example, more severely affected epileptics are more likely to have accidents, or to what degree different methods of diabetes management may affect the risk of mishaps. The study found that traffic tickets issued for volitional infractions, such as speeding, were not more common among the patient groups. However, citations for infractions such as careless driving were more common in these two groups of drivers. This might suggest that although the major symptoms of the disease are controlled, residual impairments may affect driving risks, and are certainly worthy of further investigation. There has been a traditional tendency to consider only obvious and severe impairments to driving ability. However, subtle deficits may make a significant contribution to accident statistics. Subtle deficits may also be important for healthy people as they grow older. As the population ages, there may be more people on the road with slower reflexes, impaired decision making under pressure, poor night vision, and increased frailty. While advanced age alone can not be a disqualifying factor for driving privileges, the subtle deficits that may contribute to traffic accidents will remain a fruitful, if controversial, subject for safety research. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Risk factors, Demographic aspects, Diabetes, Diabetes mellitus, Epilepsy, Automobile driving, Motor vehicle driving, Traffic accidents, editorial

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Effects of desipramine, amitriptyline, and fluoxetine on pain in diabetic neuropathy

Article Abstract:

Desipramine may be as effective as the more commonly used amitriptyline for relieving pain in patients with diabetic neuropathy (general disorders of the nervous system). Of 84 patients with diabetic neuropathy, 38 were treated with desipramine and amitriptyline, and 46 were treated with fluoxetine and placebo. Moderate or better pain relief was experienced by 23 of the 38 patients (61%) treated with desipramine, 28 of the 38 patients (74%) treated with amitriptyline, 22 of the 46 patients (48%) treated with fluoxetine and 19 of the 46 patients (41%) treated with a placebo. Differences in pain relief between desipramine and amitriptyline were not significant. The differences in pain relief between the placebo and fluoxetine were also not significant. Patients treated with desipramine or amitriptyline experienced significant pain relief, compared with those treated with the placebo. Pain relief by desipramine and amitriptyline was approximately the same among patients who were depressed compared with those who were not. Fluoxetine alleviated pain more than the placebo only in depressed patients.

Health aspects, Drug therapy, Fluoxetine, Diabetic neuropathies, Desipramine, Amitriptyline

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