Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 47
Filtrar
1.
Accid Anal Prev ; 151: 105965, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33429206

RESUMO

OBJECTIVE: The aim of the study is to compare driving exposure, patterns and factors associated with safety critical events between drivers with MCI and a comparison group without cognitive impairment. DESIGN, SETTING, PARTICIPANTS: Naturalistic driving data using an in-vehicle monitoring device were collected from 36 older drivers with MCI and 35 older drivers without cognitive impairment over a two-week period in Western Australia. MEASUREMENTS: Naturalistic driving exposure, patterns (eg. night-time trips, peak-hour trips) and safety critical events (harsh acceleration, harsh braking and harsh cornering). RESULTS: Drivers with MCI had a lower number of safety critical events (mean = 7.20, SD = 11.44) compared to drivers without cognitive impairment (mean = 10.89, SD = 23.30) however, this was not statistically significantly. There were also no statistically significant differences between drivers with and without MCI for measures of driving exposure or any of the driving patterns including weekday trips, night-time trips and trips on highways/freeways. The results of the multivariable modelling found only binocular contrast sensitivity was associated with the rate of safety critical events. For every increase of 0.1 log units in contrast sensitivity (better contrast sensitivity) the rate of safety critical events significantly decreased by 30 % (IRR = 0.70, 95 % CI = 0.50-0.98, p = 0.04). CONCLUSION: Drivers with MCI were found to have similar driving exposure and patterns compared to older drivers without cognitive impairment, however drivers with better contrast sensitivity experienced fewer safety critical events. Future research should consider a longitudinal study design with an extended driving monitoring period and a larger sample with a clinical diagnosis of MCI to assess changes in cognition and its impact on driving.

2.
Accid Anal Prev ; 146: 105758, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32947208

RESUMO

This study aimed to determine the risk factors associated with unsafe events involving a motor vehicle, that occurred while group riding (cycling) in Perth, Western Australia. Naturalistic video footage was collected from 52 group riders and unsafe events identified. A case-crossover study was used to compare the road infrastructure and group behavioural characteristics of 108 case sites where unsafe events occurred to 216 control sites where no unsafe events occurred. After controlling for potential confounding factors, roundabouts increased the risk of an unsafe event compared to midblocks (odds ratio (OR): 3.63, 95% confidence interval (CI): 1.57-8.42, p = 0.003), priority control intersections (OR: 4.36, 95% CI: 1.49-12.76, 0.007) and traffic signal intersections (OR: 5.57, 95% CI: 1.42-21.79, p = 0.014). Raised traffic islands (OR: 2.30, 95% CI: 1.41-3.78, p = 0.001), posted speed limits of ≥60 km per hour (OR: 2.45, 95% CI: 1.55-3.86, p < 0.001) and group rider traffic violations (OR: 2.51, 95% CI: 1.14-5.53, p = 0.022) also significantly increased the risk of an unsafe event. Riding two abreast in the traffic lane (OR: 0.50, 95% CI: 0.32-0.76, p = 0.002) or having all riders in the bicycle lane (OR: 0.14, 95% CI: 0.04-0.51, p = 0.003), significantly reduced the risk of an unsafe event, compared to riding single file in the traffic lane. Simple road infrastructure treatments on popular group riding routes as well as education targeting both group riders and motorists, could reduce unsafe events and promote a safer, more inclusive shared road environment for group riders.

3.
Accid Anal Prev ; 146: 105726, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32818761

RESUMO

This study firstly aimed to describe bicyclists' return to cycling after a hospitalisation crash. Secondly, it aimed to determine factors associated with reduced cycling post-crash. A study of 83 cyclists hospitalised due to an on-road crash was undertaken in Perth, Western Australia. Participants completed a questionnaire shortly following the crash and were followed up approximately 12 months after the crash. Injury information was obtained from the WA State Trauma Registry. A binary logistic regression model was used to examine factors associated with 'reduced cycling exposure' at follow-up. Sixty percent of participants had 'reduced cycling exposure' and 40% had 'no reduction in cycling exposure' at follow up. Twenty-two percent of participants had not cycled at all since the crash. Despite 46% reporting fear of crashing/ lack of confidence as a reason for 'reduced cycling exposure', only 7% of all participants had received any counselling. After controlling for confounding factors, those who participated in group riding before the crash (OR: 0.24, 95% CI: 0.08-0.66, p = 0.006) and those who had a 'complete functional recovery' (OR: 0.15, 95% CI: 0.04-0.64, p = 0.011), had lower odds of 'reduced cycling exposure' at follow-up. In addition, those who were not employed full time at baseline had higher odds of 'reduced cycling exposure' at follow up (OR: 3.72, 95% CI: 1.22-11.33, p = 0.021). Provision of psychological services following a bicycle crash may be an important intervention for improving levels of fear and confidence surrounding cycling and assisting cyclists in returning to their pre-crash level of participation. In addition, interventions promoting return to cycling, should be targeted towards non-group riders who cycle for either commuting or recreational purposes.

4.
Accid Anal Prev ; 145: 105710, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32777558

RESUMO

The aim of the study was to investigate the impact of digital billboards on driving performance and visual attention. The impact of dwell time, location and content of digital billboards on driving behaviour was also examined. A 3 × 2 × 2 × 2 experimental study was undertaken using a laboratory driving simulator and data analysed using factorial four-way analysis of variance. A total of 96 participants completed the study, ranging in age from 18 to 76 years. On sections of roads containing billboards, participants drove at lower mean speeds (p < 0.001), had more speed variability (p < 0.001), more variability in lane position (p < 0.001), more time spent at high risk headway < two seconds (p = 0.013), more time spent at high risk headway <0.25 s (p = 0.002) and had more visual fixations (p = 0.01), compared to control sections of road with no billboards. Billboards with simple (versus complex) content presented at a long dwell time (60 s versus 40 or 20 s) had the least negative impact on driving outcomes. Billboards with complex content had similar negative effects on driving, regardless of dwell time. In addition, post-mounted roadside billboards (versus bridge mounted) with 60 s dwell times had the least negative impact on driving. While the presence of digital billboards negatively affected driving performance, simple billboard content and longer dwell times were safer. The results of the study will assist in the development of evidence-based guidelines for digital billboards.

5.
Accid Anal Prev ; 141: 105541, 2020 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-32360994

RESUMO

The Rural Intersection Active Warning System (RIAWS) is an innovative road safety treatment designed to slow traffic on major approaches to a high-risk rural intersection when vehicles are turning or crossing into or out of the side roads, thus reducing fatal and serious casualties. A 2 × 2 experimental driving simulation study was undertaken which aimed to determine the impact of signage (RIAWS versus traditional painted) and sign content (80 km/h versus slow down) on drivers' instantaneous speed at rural intersections. The driving simulator assessment was completed by 96 drivers aged between 18 and 80 years with a current WA C class licence (passenger vehicle). This provided a total of 384 observations. The results of a two-way ANOVA found a significant interaction effect between speed signage and sign content (F(1,3) = 11.78, p < 0.001). The RIAWS "80 km/h" sign resulted in significantly lower instantaneous speeds than all other types of signs including RIAWS "slow down signs (p < 0.001), traditional painted "80 km/h" signs (p = 0.023) and traditional painted "slow down" signs (p = 0.001). Overall, the study found that RIAWS "80 km/h" sign and not the RIAWS "slow down" sign provided the most effective option for reducing driver speeds on approach to rural intersections. Further research is needed to determine the most effective placement of the RIAWS "80 km/h" signs and how they perform on curved roads.

6.
Accid Anal Prev ; 136: 105407, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31869695

RESUMO

Faced with the current growth and change to Western Australia's road network as well as the promotion and increased uptake of cycling, further investigation into crash, injury and road infrastructure characteristics is necessary. An in-depth study was conducted of 100 cyclists who were injured due to involvement in a crash that occurred on-road and resulted in an admission to a hospital. Information collected included a researcher-administered questionnaire, crash details from the Integrated Road Information System (IRIS), injury information from the State Trauma Registry and a virtual on-line site inspection. Overall, 42 % of crashes involved a motor vehicle and 58 % did not involve a motor vehicle. Twenty-one percent of all crashes involved cyclist loss of control, 18% were crashes with another cyclist, 18% involved hitting an object and 1% involved a pedestrian. . Bicycle crashes were severely under-reported with only 40 percent reported to the Police. Approximately half of crashes occurred at intersections (51 %) and half at midblock (non-intersection) sites (49 %). Fifty-seven percent of crashes that occurred at intersections involved a motor vehicle, whereas only 27% of crashes that occurred at midblocks involved a motor vehicle. The majority of cyclists' injuries were classified as minor according to the Injury Severity Score with the mean number of body regions injured being 4.5 (SD = 2.2). The mean number of days in hospital care was 5.2 days (SD = 5.6, range: 1-33). These findings can be used to guide road infrastructure treatments that reduce the risk of bicycle crashes in Western Australia and insights may inform action in other jurisdictions where cycling is increasing in popularity.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Ciclismo/lesões , Ambiente Construído/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Humanos , Escala de Gravidade do Ferimento , Masculino , Sistema de Registros , Austrália Ocidental , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etiologia
7.
Accid Anal Prev ; 129: 342-349, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31200122

RESUMO

This study aimed to identify features of the road environment that increased the risk of on-road bicycle crashes in Perth, Australia between 2014-2017. This case-control study used a combination of an in-depth crash study and naturalistic study to compare the road environment characteristics of 100 case (crash) sites and 300 control sites where no crash occurred using conditional logistic regression. For intersection sites, roundabouts (adjusted OR: 2.98, 95% CI: 1.18, 7.56) and traffic lights (adjusted OR: 3.86, 95% CI 1.29, 11.63) significantly increased the risk of a bicycle crash, compared to priority control/uncontrolled intersections. For midblock (non-intersection) sites, roads with an incline (upwards/downwards) significantly increased the risk of a crash (adjusted OR: 3.39, 95% CI: 1.02, 11.22), compared to level roads. This study highlighted the risk of roundabouts, traffic lights and roads with an incline for bicycle crashes. Treatments that reduce vehicle speeds and encourage cyclists to claim the lane at roundabouts, as well as careful road design and road maintenance at traffic lights, may reduce the risk of crashes for cyclists. While it is impossible to remove hills and slopes from the topography, it is possible to select routes to target for bicycle infrastructure which are predominantly level.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Ciclismo/estatística & dados numéricos , Planejamento Ambiental/estatística & dados numéricos , Acidentes de Trânsito/classificação , Acidentes de Trânsito/prevenção & controle , Adulto , Austrália , Ciclismo/lesões , Estudos de Casos e Controles , Planejamento Ambiental/normas , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Segurança
8.
BMJ Open ; 9(3): e024491, 2019 03 20.
Artigo em Inglês | MEDLINE | ID: mdl-30898810

RESUMO

OBJECTIVES: To investigate the impact of first eye and second eye cataract surgery on the level of physical activity undertaken by older adults with bilateral cataract. DESIGN: Prospective cohort study. SETTING: Three public ophthalmology clinics in Western Australia. PARTICIPANTS: Fifty-five older adults with bilateral cataract aged 55+ years, awaiting first eye cataract surgery. OUTCOME MEASURES: The primary outcome measure was participation in moderate leisure-time physical activity. The secondary outcomes were participation in walking, gardening and vigorous leisure-time physical activity. Participants completed a researcher-administered questionnaire, containing the Active Australia Survey and visual tests before first eye cataract surgery, after first eye surgery and after second eye surgery. A Generalised Estimating Equation linear regression model was undertaken to analyse the change in moderate leisure-time physical activity participation before first eye surgery, after first eye surgery and after second eye surgery, after accounting for relevant confounders. RESULTS: Participants spent significantly less time per week (20 min) on moderate leisure-time physical activity before first eye cataract surgery compared with after first eye surgery (p=0.04) after accounting for confounders. After second eye cataract surgery, participants spent significantly more time per week (32 min) on moderate physical activity compared with after first eye surgery (p=0.02). There were no significant changes in walking, gardening and vigorous physical activity throughout the cataract surgery process. CONCLUSION: First and second eye cataract surgery each independently increased participation in moderate leisure-time physical activity. This provides a rationale for timely first and second eye cataract surgery for bilateral cataract patients, even when they have relatively good vision.


Assuntos
Catarata/terapia , Exercício Físico , Atividades de Lazer , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e Questionários , Tempo para o Tratamento , Austrália Ocidental
9.
Age Ageing ; 48(1): 128-133, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30265273

RESUMO

Objective: to evaluate the association between first- and second-eye cataract surgery and motor vehicle crashes for older drivers and the associated costs to the community. Design: retrospective population-based cohort study. Subjects: a total of 2,849 drivers aged 60 years and older who had undergone both first- and second-eye cataract surgery were involved in 3,113 motor vehicle crashes as drivers during the study period. Methods: de-identified data were obtained using the Western Australian Data Linkage System from 1 January 2003 to 31 December 2015. Poisson regression analysis based on Generalised Estimating Equations was undertaken to compare the frequency of crashes in the year before first eye cataract surgery, between first and second eye surgery and 1 year after second eye surgery. Results: first eye cataract surgery was associated with a significant 61% reduction in crash frequency (P < 0.001) and second eye surgery was associated with a significant 23% reduction in crashes (P < 0.001), compared to the year before first eye cataract surgery after accounting for age, gender, marital status, accessibility, socio-economic status, driving exposure and comorbidities. The estimated cost savings from the reduction in crashes in the year after second eye cataract surgery compared to the year before first eye cataract surgery was $14.9 million. Conclusions: first- and second-eye cataract surgery were associated with a significant reduction in motor vehicle crashes, with first eye surgery having the greatest impact. These results provide encouragement for the timely provision of first- and second-eye cataract surgery for older drivers.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Extração de Catarata/estatística & dados numéricos , Acidentes de Trânsito/economia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Extração de Catarata/economia , Custos e Análise de Custo/estatística & dados numéricos , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Austrália Ocidental
10.
Clin Interv Aging ; 13: 1457-1464, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30197507

RESUMO

Purpose: The purpose of this study was to investigate the impact of the first and second eye cataract surgeries on the risk of falls in participants with bilateral cataract and to determine which changes in visual measures are associated with changes in the number of falls throughout the cataract surgery process. Patients and methods: Fifty-five older adults with bilateral cataract aged 55+ years were assessed at three time points during the cataract surgery process, and they completed a falls diary. Two separate generalized estimating equation-negative binomial models were undertaken to assess changes in the number of falls before first eye cataract surgery, between first and second eye surgeries, and after second eye cataract surgery and which changes in visual measures were associated with changes in the number of falls. Results: After adjusting for potential confounding factors, the risk of falls decreased by 54% (incidence rate ratio (IRR) =0.458, 95% CI=0.215-0.974, p=0.04) after first eye cataract surgery only, compared with the period before first eye surgery. The risk of falls decreased by 73% (IRR =0.268, 95% CI =0.114-0.628, p=0.002) after second eye cataract surgery, compared with the period before first eye surgery. Improved binocular visual acuity (IRR =5.488, 95% CI =1.191-25.282, p=0.029) and contrast sensitivity (IRR =0.257, 95% CI =0.070-0.939, p=0.040) were associated with a decrease in the number of falls. Conclusion: The study found that first and second eye cataract surgeries reduced the risk of falls among a cohort of bilateral cataract patients with relatively good baseline vision. This suggests that timely first and second eye cataract surgeries could play an important role in reducing the burden due to falls among older adults with cataract.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Extração de Catarata/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Sensibilidades de Contraste , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Acuidade Visual
11.
BMC Geriatr ; 18(1): 51, 2018 02 17.
Artigo em Inglês | MEDLINE | ID: mdl-29454304

RESUMO

BACKGROUND: Driving a car is the most common form of transport among the older population. Common medical conditions such as cataract, increase with age and impact on the ability to drive. To compensate for visual decline, some cataract patients may self-regulate their driving while waiting for cataract surgery. However, little is known about the self-regulation practices of older drivers throughout the cataract surgery process. The aim of this study is to assess the impact of first and second eye cataract surgery on driver self-regulation practices, and to determine which objective measures of vision are associated with driver self-regulation. METHODS: Fifty-five older drivers with bilateral cataract aged 55+ years were assessed using the self-reported Driving Habits Questionnaire, the Mini-Mental State Examination and three objective visual measures in the month before cataract surgery, at least one to three months after first eye cataract surgery and at least one month after second eye cataract surgery. Participants' natural driving behaviour in four driving situations was also examined for one week using an in-vehicle monitoring device. Two separate Generalised Estimating Equation logistic models were undertaken to assess the impact of first and second eye cataract surgery on driver-self-regulation status and which changes in visual measures were associated with driver self-regulation status. RESULTS: The odds of being a self-regulator in at least one driving situation significantly decreased by 70% after first eye cataract surgery (OR: 0.3, 95% CI: 0.1-0.7) and by 90% after second eye surgery (OR: 0.1, 95% CI: 0.1-0.4), compared to before first eye surgery. Improvement in contrast sensitivity after cataract surgery was significantly associated with decreased odds of self-regulation (OR: 0.02, 95% CI: 0.01-0.4). CONCLUSIONS: The findings provide a strong rationale for providing timely first and second eye cataract surgery for older drivers with bilateral cataract, in order to improve their mobility and independence.


Assuntos
Condução de Veículo , Extração de Catarata/tendências , Catarata/complicações , Catarata/diagnóstico , Autorrelato , Idoso , Idoso de 80 Anos ou mais , Condução de Veículo/normas , Estudos de Coortes , Sensibilidades de Contraste/fisiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Autorrelato/normas , Inquéritos e Questionários
12.
Disabil Rehabil ; 40(26): 3206-3216, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-28969457

RESUMO

BACKGROUND: Postcolonial analysis can help rehabilitation providers understand how colonization and racialization create and sustain health inequities faced by indigenous peoples. However, there is little guidance in the literature regarding inclusion of postcolonialism within rehabilitation educational curricula. Therefore, this study explored perspectives regarding educational content related to postcolonialism and indigenous health that rehabilitation students in Canada should learn to increase health equity. METHODS: This qualitative study involved in-depth, semi-structured interviews with 19 individuals with insight into postcolonialism and health in Canada. Data were analyzed collaboratively to identify, code, and translate themes according to a structured six-phase method. RESULTS: Four themes emerged regarding educational content for rehabilitation students: (1) the historic trauma of colonization and its ongoing impacts on rehabilitation for indigenous peoples; (2) disproportionate health burden and inequitable access to health services; (3) how rehabilitation is related to Indigenous ways of knowing; and (4) why rehabilitation is well-positioned to address health inequities with Indigenous Peoples. CONCLUSION: Results call for reflection on assumptions underpinning the rehabilitation professions that may unintentionally reinforce health inequities. A postcolonial lens can help rehabilitation educators promote culturally safe services for people whose ill health and disability are linked to the effects of colonization. Implications for Rehabilitation Given the powerful, ongoing effects of colonization and racialization on health and disability, recommendation #24 from the Truth and Reconciliation Commission of Canada calls for the education of health professionals related to Indigenous history, rights, and anti-racism. However, there is little curricula on these areas in the education of rehabilitation professional students or in continuing education programs for practicing clinicians. This is the first study to investigate expert perspectives on content related to postcolonialism and indigenous-settler inequities that should be included in the education of rehabilitation students in Canada. According to the participants in this study, rehabilitation educators in Canada should consider incorporating the following four themes into curricula to better address Indigenous-settler inequities in the context of rehabilitation: (1) the historic trauma of colonization and its ongoing impacts on rehabilitation for Indigenous Peoples in Canada; (2) disproportionate health burden and inequitable access to health services; (3) how rehabilitation is related to Indigenous ways of knowing; and (4) why rehabilitation is well-positioned to rise to the challenge of addressing health inequities with Indigenous Peoples in Canada. Postcolonialism is useful for rehabilitation providers because it is an approach that redirects the focus of problems from Indigenous People to the systems of oppression (specifically colonization and racialization) that cause ill health and disability.


Assuntos
Currículo , Equidade em Saúde/normas , Racismo , Reabilitação/educação , Estudantes de Ciências da Saúde/psicologia , Canadá/etnologia , Colonialismo , Feminino , Disparidades em Assistência à Saúde/etnologia , Humanos , Masculino , Pesquisa Qualitativa , Racismo/prevenção & controle , Racismo/psicologia
13.
Inj Prev ; 24(6): 405-410, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-28823996

RESUMO

BACKGROUND: Use of mobile phones and portable audio equipment and alcohol are known to negatively affect cycling ability. Evidence suggests that cyclists may be less likely to engage in these behaviours while riding in a group; however, it is unknown whether group riders are also at reduced risk when participating in non-group riding. OBJECTIVE: To examine the association between group riding participation and the use of mobile phones and portable audio equipment and alcohol while non-group riding in Perth, Western Australia. METHODS: A cross-sectional analysis of an online questionnaire was undertaken. Group and exclusive non-group riders were compared and separate binary logistic regression models were used to examine the association between group riding participation and the use of mobile phones and portable audio equipment and alcohol while non-group riding, controlling for gender, age, education and frequency of non-group riding. RESULTS: Participants included 365 cyclists: 187 exclusive non-group riders (51.2%) and 178 group riders (48.8%). Group riders were less likely to have possibly cycled while over the legal blood alcohol limit in the past 12 months (OR: 0.56, 95% CI 0.34 to 0.92) and were less likely to ever use portable audio equipment (OR: 0.57, 95% CI 0.34 to 0.94) than exclusive non-group riders, while participating in non-group riding. Group riding status was not associated with mobile phone use. CONCLUSIONS: This study provides early evidence that there may be differences between group and non-group riders that impact on their safety behaviours while participating in non-group riding.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Consumo de Bebidas Alcoólicas/efeitos adversos , Atenção/fisiologia , Ciclismo/lesões , Telefone Celular/estatística & dados numéricos , Rádio/estatística & dados numéricos , Adulto , Ciclismo/psicologia , Telefone Celular/instrumentação , Estudos Transversais , Feminino , Perda Auditiva Provocada por Ruído , Humanos , Masculino , Pessoa de Meia-Idade , Rádio/instrumentação , Fatores de Risco , Assunção de Riscos , Inquéritos e Questionários , Austrália Ocidental/epidemiologia
14.
Clin Interv Aging ; 12: 1911-1920, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29184397

RESUMO

Objectives: To analyze the association between visual impairment and driver self-regulation among a cohort of older drivers waiting for first eye cataract surgery. Methods: Ninety-six drivers with bilateral cataract aged 55+ years were assessed before first eye cataract surgery. Data collection consisted of a researcher-administered questionnaire, objective visual measures (visual acuity, contrast sensitivity and stereopsis), a visual attention test (the useful field of view test) and a cognitive test (the Mini-Mental State Examination). Driver self-regulation practices were collected using the Driving Habits Questionnaire and were also measured with an in-vehicle monitoring device. Characteristics of self-regulators and non-self-regulators were compared and a logistic regression model was used to examine the association between 3 objective visual measures and driver self-regulation status. Results: After controlling for potential confounding factors, only binocular contrast sensitivity (p=0.01), age (p=0.03) and gender (p=0.03) were significantly associated with driver self-regulation status. The odds of participants with better contrast sensitivity scores (better vision) self-regulating their driving in at least 1 driving situation decreased (odds ratio [OR]: 0.01, 95% CI: 0.00-0.28) while those of increasing age reported an increased odds of self-regulating their driving (OR: 1.08, 95% CI: 1.01-1.15). The odds of males self-regulating their driving was decreased compared with females (OR: 0.28, 95% CI: 0.09-0.86). Conclusions: Worse binocular contrast sensitivity scores, increasing age and being female were significantly associated with driver self-regulation. The study highlighted that while self-regulation was common among cataract patients, a proportion of those with poor vision did not self-regulate. Further research should determine how cataract patients could benefit from self-regulation strategies while waiting for cataract surgery.


Assuntos
Condução de Veículo , Catarata/fisiopatologia , Idoso , Atenção , Extração de Catarata , Estudos de Coortes , Sensibilidades de Contraste , Feminino , Humanos , Modelos Logísticos , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Acuidade Visual
15.
Physiother Can ; 69(2): 161-170, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28539696

RESUMO

Purpose: People with dementia fall more often than cognitively healthy older adults, but their risk factors are not well understood. A review is needed to determine a fall risk profile for this population. The objective was to critically evaluate the literature and identify the factors associated with fall risk in older adults with dementia. Methods: Articles published between January 1988 and October 2014 in EMBASE, PubMed, PsycINFO, and CINAHL were searched. Inclusion criteria were participants aged 55 years or older with dementia or cognitive impairment, prospective cohort design, detailed fall definition, falls as the primary outcome, and multi-variable regression analysis. Two authors independently reviewed and extracted data on study characteristics, quality assessment, and outcomes. Adjusted risk estimates were extracted from the articles. Results: A total of 17 studies met the inclusion criteria. Risk factors were categorized into demographic, balance, gait, vision, functional status, medications, psychosocial, severity of dementia, and other. Risk factors varied with living setting and were not consistent across all studies within a setting. Conclusion: Falls in older adults with dementia are associated with multiple intrinsic and extrinsic risk factors, some shared with older adults in general and others unique to the disease. Risk factors vary between community- and institution-dwelling samples of adults with dementia or cognitive impairment.

16.
Accid Anal Prev ; 99(Pt B): 452-458, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26643650

RESUMO

OBJECTIVE: To determine the association between a heavy vehicle driver's work environment, including fatigue-related characteristics, and the risk of a crash in Western Australia. METHODS: This case-control study included 100 long-haul heavy vehicle drivers who were involved in a police-reported crash in WA and 100 long-haul heavy vehicle drivers recruited from WA truck stops, who were not involved in a crash in the previous 12 months. Driver demographics and driving details, work environment, vehicle and sleep-related characteristics were obtained using an interviewer-administered questionnaire. Drivers were tested for obstructive sleep apnoea using an overnight diagnostic device. Conditional multiple logistic regression analysis was undertaken to determine work environment-related factors associated with crash involvement. RESULTS: After accounting for potential confounders, driving a heavy vehicle with an empty load was associated with almost a three-fold increased crash risk compared to carrying general freight (adjusted OR: 2.93, 95% CI: 1.17-7.34). Driving a rigid heavy vehicle was associated with a four-fold increased risk of crashing compared to articulated heavy vehicles (adjusted OR: 4.08, 95% CI: 1.13-14.68). The risk of crashing was almost five times higher when driving more than 50% of the trip between midnight and 5.59am (adjusted OR: 4.86, 95% CI: 1.47-16.07). Furthermore, the risk of crashing significantly increased if the time since the last break on the index trip was greater than 2h (adjusted OR: 2.18, 95% CI: 1.14-4.17). Drivers with more than 10 years driving experience were 52% less likely to be involved in a crash (adjusted OR: 0.48, 95% CI: 0.23-0.99). CONCLUSION: The results provide support for an association between a driver's work environment, fatigue-related factors, and the risk of heavy vehicle crash involvement. Greater attention needs to be paid to the creation of a safer work environment for long distance heavy vehicle drivers.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Condução de Veículo/estatística & dados numéricos , Fadiga/epidemiologia , Veículos Automotores/estatística & dados numéricos , Local de Trabalho/estatística & dados numéricos , Adulto , Estudos de Casos e Controles , Fadiga/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Sono , Austrália Ocidental , Adulto Jovem
17.
BMC Neurol ; 16(1): 188, 2016 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-27687085

RESUMO

BACKGROUND: Older adults with dementia are at an increased risk of falls, however, little is known about risk factors for recurrent injurious falls (a subsequent fall after the first fall has occurred) among this group. This study aimed to identify risk factors for recurrent injurious falls requiring hospitalization among adults aged 60+ years with dementia. METHODS: This retrospective, whole-population cohort study was conducted using the Western Australian Hospital Morbidity Data System and Western Australian Death Registrations from 2001 to 2013. Survival analysis using a stratified conditional Cox model (type 1) was undertaken to identify risk factors for recurrent injurious falls requiring hospitalization. RESULTS: There were 32,519 participants with an index hospital admission with dementia during the study period. Over 27 % (n = 8970) of the cohort experienced a total of 11,073 injurious falls requiring hospitalization during follow up with 7297 individuals experiencing a single fall, 1330 experiencing two falls and 343 experiencing three or more falls. The median follow-up time for each individual was 2.49 years. Females were at a significantly increased risk of 7 % for recurrent injurious falls resulting in hospitalization (adjusted hazard ratio 1.07, 95 % CI 1.01-1.12), compared to males. Increasing age, living in rural areas, and having an injurious fall in the year prior to the index hospital admission with dementia also increased the risk of recurrent injurious falls resulting in hospitalization. CONCLUSIONS: Screening those with dementia for injurious falls history could help to identify those most at risk of recurrent injurious falls. Improvement of heath care and falls prevention services for those with dementia who live in rural areas may also reduce recurrent injurious falls.

18.
J Cataract Refract Surg ; 42(5): 788-94, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-27255257

RESUMO

UNLABELLED: This comprehensive literature review summarizes published studies examining cataract and cataract surgery and driving outcomes to identify gaps in the literature that require further research. Six electronic databases were searched for articles published up to and including March 2015. Articles were reviewed if they included older drivers with cataract or drivers who had cataract surgery and at least 1 of the following driving outcomes: crash risk, driving self-regulation practices, and driving performance. There was consistent evidence that cataract negatively affects driving and that cataract surgery is beneficial to driving outcomes. Future research should examine the separate effects of first- and second-eye cataract surgery on crash risk, driving self-regulation, and driving performance. It should also determine how visual measures relate to driving performance among cataract patients so those most at risk for driving difficulties can be identified, advised, and possibly prioritized for surgery. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.


Assuntos
Condução de Veículo , Extração de Catarata , Catarata/complicações , Acidentes de Trânsito , Idoso , Terapia Comportamental , Sensibilidades de Contraste , Humanos , Fatores de Risco , Autoimagem
19.
BMC Med Educ ; 15: 155, 2015 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-26400722

RESUMO

BACKGROUND: The ongoing role of colonialism in producing health inequities is well-known. Postcolonialism is a theoretical approach that enables healthcare providers to better understand and address health inequities in society. While the importance of postcolonialism and health (PCH) in the education of clinicians has been recognized, the literature lacks guidance on how to incorporate PCH into healthcare training programs. This study explores the perspectives of key informants regarding content related to PCH that should be included in Canadian healthcare training programs, and how this content should be delivered. METHODS: This qualitative study involved in-depth, semi-structured interviews with nineteen individuals with insight into PCH in Canada. Data were analyzed collaboratively to identify, code and translate key emergent themes according to the six phases of the DEPICT method. RESULTS: Three themes emerged related to incorporating PCH into Canadian healthcare training programs: (1) content related to PCH that should be taught; (2) how this content should be delivered, including teaching strategies, who should teach this content and when content should be taught, and; (3) why this content should be taught. For the Canadian context, participants advised that PCH content should include a foundational history of colonization of Aboriginal Peoples in Canada, how structures rooted in colonialism continue to produce health inequities, and how Canadian clinicians' own experiences of privilege and oppression affect their practice. Participants also advised that this content should be integrated longitudinally through a variety of interactive teaching strategies and developed in collaboration with Aboriginal partners to address health inequities. CONCLUSIONS: These findings reinforce that clinicians and educators must understand health and healthcare as situated in social, political and historical contexts rooted in colonialism. Postcolonialism enables learners to understand and respond to how colonialism creates and sustains health inequities. This empirical study provides educators with guidance regarding PCH content and delivery strategies for healthcare training programs. More broadly, this study joins the chorus of voices calling for critical reflection on the limits and harms of an exclusively Western worldview, and the need for action to name and correct past wrongs in the spirit of reconciliation and justice for all.


Assuntos
Competência Cultural/educação , Equidade em Saúde/normas , Pessoal de Saúde/educação , Disparidades nos Níveis de Saúde , Índios Norte-Americanos/psicologia , Inuítes/psicologia , Determinantes Sociais da Saúde/etnologia , Canadá , Colonialismo/história , Feminino , Pessoal de Saúde/psicologia , Pessoal de Saúde/normas , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Índios Norte-Americanos/história , Índios Norte-Americanos/legislação & jurisprudência , Entrevistas como Assunto , Inuítes/história , Inuítes/legislação & jurisprudência , Masculino , Pesquisa Qualitativa , Racismo
20.
J Clin Sleep Med ; 11(4): 413-8, 2015 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-25580608

RESUMO

STUDY OBJECTIVES: To determine the association between obstructive sleep apnea (OSA), health-related factors and the likelihood of heavy vehicle crashes in Western Australia (WA). METHODS: This case-control study included 100 long-haul heavy vehicle drivers who were involved in a police-reported crash in WA during the study period (cases) and 100 long-haul heavy vehicle drivers recruited from WA truck stops, who were not involved in a crash during the past year (controls). Driver demographics, health, and fatigue-related characteristics were obtained using an interviewer administered questionnaire. Drivers were tested for OSA using a diagnostic Flow Wizard. Logistic regression was used to determine health-related factors associated with crash involvement among long distance heavy vehicle drivers. RESULTS: Heavy vehicle drivers diagnosed with OSA through the use of the FlowWizard were over three times more likely to be involved in a crash than drivers without OSA (adjusted OR: 3.42, 95% CI: 1.34-8.72). The risk of crash was significantly increased if heavy vehicle drivers reported a diagnosis of depression (adjusted OR: 6.59, 95% CI: 1.30-33.24) or had not completed fatigue management training (adjusted OR: 6.05, 95% CI: 1.80-20.24). Crash risk was 74% lower among older drivers (> 35 years) than younger drivers (adjusted OR: 0.25, 95% CI: 0.08-0.82). CONCLUSION: The results suggest that more rigorous screening and subsequent treatment of OSA and depression by clinicians as well as compulsory fatigue management training may reduce crashes among heavy vehicle drivers. COMMENTARY: A commentary on this article appears in this issue on page 409.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Apneia Obstrutiva do Sono/complicações , Adulto , Fatores Etários , Idoso , Condução de Veículo/psicologia , Condução de Veículo/estatística & dados numéricos , Estudos de Casos e Controles , Depressão/complicações , Depressão/psicologia , Fadiga/prevenção & controle , Fadiga/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Veículos Automotores/estatística & dados numéricos , Fatores de Risco , Apneia Obstrutiva do Sono/psicologia , Inquéritos e Questionários , Austrália Ocidental/epidemiologia , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...