Trends in the crash involvement of older drivers in Australia.

Research from the USA and Great Britain indicates that the number of fatal crashes (as well as the rates of crashes of all levels of injury and property damage) involving older drivers declined between approximately 1997 and 2010 despite increases in the number of older drivers on the road and in their driving exposure. Differing results have been found in Australian research with the number of older driver fatalities having been steady and even slightly increasing between 2004 and 2013. The present study further examined trends in the crash involvement of older drivers in Australia to determine whether their involvement has been increasing or decreasing, and how this compares to trends for younger aged drivers. Crash, injury, population and licensure data were examined by age group for the years 2003-2012. There were increases in the population and licensure of drivers aged 65 years and older, while the total crashes, serious injuries, and fatalities remained steady for drivers aged 65-84 and increased for the oldest group (85+) between 2003 and 2012. Increasing trends were also found for drivers 85 and older for rates of serious or fatal injuries per head of population and per licensed driver. Population and licensure among younger age groups also increased but their crash numbers and crash rates remained steady or declined. The stable or slightly increasing fatal crash involvement of older drivers in Australia contrasts with the declining trends in the USA and Great Britain. Therefore, greater attention should be given to the road safety of older drivers in Australia.

A trial of retrofitted advisory collision avoidance technology in government fleet vehicles.

In-vehicle collision avoidance technology (CAT) has the potential to prevent crash involvement. In 2015, Transport for New South Wales undertook a trial of a Mobileye 560 CAT system that was installed in 34 government fleet vehicles for a period of seven months. The system provided headway monitoring, lane departure, forward collision and pedestrian collision warnings, using audio and visual alerts. The purpose of the trial was to determine whether the technology could change the driving behaviour of fleet vehicle drivers and improve their safety. The evaluation consisted of three components: (1) analysis of objective data to examine effects of the technology on driving behaviour, (2) analysis of video footage taken from a sample of the vehicles to examine driving circumstances that trigger headway monitoring and forward collision warnings, and (3) a survey completed by 122 of the 199 individuals who drove the trial vehicles to examine experiences with, and attitudes to, the technology. Analysis of the objective data found that the system resulted in changes in behaviour with increased headway and improved lane keeping, but that these improvements dissipated once the warning alerts were switched off. Therefore, the system is capable of altering behaviour but only when it is actively providing alerts. In-vehicle video footage revealed that over a quarter of forward collision warnings were false alarms, in which a warning event was triggered despite there being no vehicle travelling ahead. The surveyed drivers recognised that the system could improve safety but most did not wish to use it themselves as they found it to be distracting and felt that it would not prevent them from having a crash. The results demonstrate that collision avoidance technology can improve driving behaviour but drivers may need to be educated about the potential benefits for their driving in order to accept the technology.

Implications of long-term care capacity response policies for an aging population: a simulation analysis.

INTRODUCTION: The demand for long-term care (LTC) services is likely to increase as a population ages. Keeping pace with rising demand for LTC poses a key challenge for health systems and policymakers, who may be slow to scale up capacity. Given that Singapore is likely to face increasing demand for both acute and LTC services, this paper examines the dynamic impact of different LTC capacity response policies, which differ in the amount of time over which LTC capacity is increased, on acute care utilization and the demand for LTC and acute care professionals. METHODS: The modeling methodology of System Dynamics (SD) was applied to create a simplified, aggregate, computer simulation model for policy exploration. This model stimulates the interaction between persons with LTC needs (i.e., elderly individuals aged 65 years and older who have functional limitations that require human assistance) and the capacity of the healthcare system (i.e., acute and LTC services, including community-based and institutional care) to provide care. Because the model is intended for policy exploration, stylized numbers were used as model inputs. To discern policy effects, the model was initialized in a steady state. The steady state was disturbed by doubling the number of people needing LTC over the 30-year simulation time. Under this demand change scenario, the effects of various LTC capacity response policies were studied and sensitivity analyses were performed. RESULTS: Compared to proactive and quick adjustment LTC capacity response policies, slower adjustment LTC capacity response policies (i.e., those for which the time to change LTC capacity is longer) tend to shift care demands to the acute care sector and increase total care needs. CONCLUSIONS: Greater attention to demand in the acute care sector relative to demand for LTC may result in over-building acute care facilities and filling them with individuals whose needs are better suited for LTC. Policymakers must be equally proactive in expanding LTC capacity, lest unsustainable acute care utilization and significant deficits in the number of healthcare professionals arise. Delaying LTC expansion could, for example, lead to increased healthcare expenditure and longer wait lists for LTC and acute care patients.

Future living arrangements of Singaporeans with age-related dementia.

BACKGROUND: With rapid aging, Singapore faces an increasing proportion of the population with age-related dementia. We used system dynamics methodology to estimate the number and proportion of people with mild, moderate, and severe dementia in future years and to examine the impact of changing family composition on their likely living arrangements. METHODS: A system dynamics model was constructed to estimate resident population, drawing birth and mortality rates from census data. We simulate future mild, moderate, and severe dementia prevalence matched with estimates of total dementia prevalence for the Asian region that includes Singapore. Then, integrating a submodel in which family size trends were projected based on fertility rates with tendencies for dependent elderly adults with dementia to live with family members, we estimate likely living arrangements of the future population of individuals with dementia. RESULTS: Though lower than other previous estimates, our simulation results indicate an increase in the number and proportion of people in Singapore with severe dementia. This and the concurrent decrease in family size point to an increasing number of individuals with dementia unlikely to live at home. CONCLUSIONS: The momenta of demographic and illness trends portend a higher number of individuals with dementia less likely to be cared for at home by family members. Traditions of care for frail elderly found in the diverse cultures of Singapore will be increasingly difficult to sustain, and care options that accommodate these demographic shifts are urgently needed.

Stakeholders' perspective on issues and challenges associated with care and treatment of aging-related cognitive impairment disorders in Singapore.

BACKGROUND: An expanding elderly population poses challenges for the provision of care and treatment for age-related physical and mental disorders. Cognitive impairment (CI)/dementia is one such mental disorder that is on the rise in Singapore and has concomitant implications for social and health systems. The objective of this study is to understand the perspectives of prominent stakeholders about current and future issues and challenges associated with CI/dementia among the elderly in Singapore. METHODS: Using indepth interviews, this qualitative study obtained the views of multiple stakeholders on issues and challenges associated with CI/dementia in Singapore. The 30 individuals interviewed as part of the study included clinicians, policy-makers, researchers, community workers, administrators, and caregivers. Using a framework approach, interview texts were indexed into domains and issues by utilizing NVivo 9.0 software. RESULTS: The stakeholders expressed concerns related to multiple domains of the CI/dementia care system: attitude and awareness, economics, education, family caregiving, inputs to care system, living arrangements, prevention, screening and diagnosis, and treatment and management of care. Within each domain, multiple issues and challenges were identified by respondents. CONCLUSIONS: The study identifies a complex set of inter-related issues and challenges that are associated with the care and treatment of people with CI/dementia. The results suggest that CI and dementia profoundly affect patients, families, and communities and that the issues related to the two disorders are truly system-wide. These findings lay the foundation for utilization of a systems approach to studying CI/dementia and provide an analytic framework for future research on complex health care issues.

Strategies for antiviral stockpiling for future influenza pandemics: a global epidemic-economic perspective.

Influenza pandemics present a global threat owing to their potential mortality and substantial economic impacts. Stockpiling antiviral drugs to manage a pandemic is an effective strategy to offset their negative impacts; however, little is known about the long-term optimal size of the stockpile under uncertainty and the characteristics of different countries. Using an epidemic-economic model we studied the effect on total mortality and costs of antiviral stockpile sizes for Brazil, China, Guatemala, India, Indonesia, New Zealand, Singapore, the UK, the USA and Zimbabwe. In the model, antivirals stockpiling considerably reduced mortality. There was greater potential avoidance of expected costs in the higher resourced countries (e.g. from $55 billion to $27 billion over a 30 year time horizon for the USA) and large avoidance of fatalities in those less resourced (e.g. from 11.4 to 2.3 million in Indonesia). Under perfect allocation, higher resourced countries should aim to store antiviral stockpiles able to cover at least 15 per cent of their population, rising to 25 per cent with 30 per cent misallocation, to minimize fatalities and economic costs. Stockpiling is estimated not to be cost-effective for two-thirds of the world's population under current antivirals pricing. Lower prices and international cooperation are necessary to make the life-saving potential of antivirals cost-effective in resource-limited countries.

Las espátulas obstétricas materno fetal y morbilidad / Obstetric spatulae and maternal-fetal morbility

Con la intención de analizar comparativamente el uso de las espátulas y el del fórceps y las posibles lesiones que se presentam en la madre y el recién nacido, se planeó un trabajo prospectivo en el hospital de alto riesgo materno infantil de Saint Joseph's de Paterson, afiliado a la Univerdidad de New Jersey. Se analizaron 51 casos de aplicación de espátulas y 55 casos de aplicación de fórceps en iguales condiciones. En ninguno de los grupos se encontraron lesiones graves de la madre o del niño. Se apreció una menor incidencia de lesiones moderadas del recién nacido en los casos de aplicación de espátulas. No se apreció ninguna lesión en los casos del grupo de las espátulas en un 92,15% de las pacientes, en contraste con un 29,00% de lesiones leves y moderadas de las pacientes del grupo de los fórceps. X2 = 43,6, p = < 0.0001