For the treatment of ACS, observational studies using PS methods produce treatment effect estimates that are of more extreme magnitude compared with those from RCTs, although the differences are rarely statistically significant.

Health Behavior and Accident Risk: Obesity Is Associated with the Future Risk of Heavy Truck Crashes among Newly Recruited Commercial DriversThis study estimates the dose-response relationship between Body Mass Index (BMI) and crash risk in commercial motor vehicle operators. Intake data was collected on 744 new truck drivers who were training for their commercial driver's licenses at a school operated by the cooperating trucking firm during the first two-week phase of instruction. Drivers were then followed prospectively on the job using the firm's operational data for two years, or until employment separation, whichever came first. Multivariate Poisson regression and Cox proportional hazards models were used to estimate the relationship between crash risk and BMI, controlling for exposure using miles driven, trip segments, and job type. Results from the Poisson regression indicated that the risk ratio (RR) for all crashes was significantly higher for drivers in the obesity Class II and Class III categories: RR= 1.6, confidence interval 1.2-2.1 and RR= 1.49, confidence interval 1.12-1.99, respectively. Similarly, the multivariate Cox Proportional Hazard model results showed that crash risk was significantly higher for obesity class II (BMI 35 to <40; relative risk (RR) = 1.47, P = 0.02) with weaker evidence of increased crash risk for obesity class III (BMI >40; RR = 1.35, P =0.06) when compared to normal BMI (BMI 18.5 to <25). The results of this prospective study establish an association between obesity and crash risk show that driver health behavior has important spillovers for public safety.

The developing field of OSA genetics is currently dominated by small and underpowered investigations. Promising findings regarding TNFA rs1800629 need to be replicated in larger studies using more comprehensive genotyping methods.

Introduction Obstructive sleep apnea (OSA) is common among commercial drivers and associated with health/safety risks, leading several trucking firms to mandate OSA screening. Methods 19,371 commercial drivers were screened for OSA with an on-line questionnaire (Somni-Sage®) through employer mandates. Questionnaire and polysomnography results were analyzed retrospectively. Results Screening categorized 5,908 (30%) drivers as higher risk. To date, employers have sent 2,103 higher risk drivers for polysomnography, demonstrating that 68% of high risk drivers tested had an apnea hypopnea index (AHI) >10 and 80% had an AHI ≥5. A conservative prevalence estimate for OSA (AHI >10) was 21% among the drivers studied. Conclusion Online screening followed by polysomnography for high-risk drivers demonstrates as many as 21% of commercial drivers may have OSA. Mandatory screening can have a high yield among commercial drivers.