The impact of first- and second-eye cataract surgery on motor vehicle crashes and associated costs.

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.

First and second eye cataract surgery and driver self-regulation among older drivers with bilateral cataract: a prospective cohort study.

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.

Risk factors for recurrent injurious falls that require hospitalization for older adults with dementia: a population based study.

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.

The impact of cataract surgery on vision-related quality of life for bilateral cataract patients in Ho Chi Minh City, Vietnam: a prospective study.

BACKGROUND: To determine the impact of cataract surgery on vision-related quality of life (VRQOL) and examine the association between objective visual measures and change in VRQOL after surgery among bilateral cataract patients in Ho Chi Minh City, Vietnam. METHODS: A cohort of older patients with bilateral cataract was assessed one week before and one to three months after first eye or both eye cataract surgery. Visual measures including visual acuity, contrast sensitivity and stereopsis were obtained. Vision-related quality of life was assessed using the NEI VFQ-25. Descriptive analyses and a generalized linear estimating equation (GEE) analysis were undertaken to measure change in VRQOL after surgery. RESULTS: Four hundred and thirteen patients were assessed before cataract surgery and 247 completed the follow-up assessment one to three months after first or both eye cataract surgery. Overall, VRQOL significantly improved after cataract surgery (p < 0.001) particularly after both eye surgeries. Binocular contrast sensitivity (p < 0.001) and stereopsis (p < 0.001) were also associated with change in VRQOL after cataract surgery. Visual acuity was not associated with VRQOL. CONCLUSIONS: Cataract surgery significantly improved VRQOL among bilateral cataract patients in Vietnam. Contrast sensitivity as well as stereopsis, rather than visual acuity significantly affected VRQOL after cataract surgery.

The impact of cataract surgery on depressive symptoms for bilateral cataract patients in Ho Chi Minh City, Vietnam.

BACKGROUND: Depression is common among older populations with cataract. However, the impact of cataract surgery on depression in both developed and developing countries remains unclear. The aim of this study is to determine the impact of cataract surgery on depressive symptoms and to examine the association between objective visual measures and change in depressive symptoms after surgery among a Vietnamese population in Ho Chi Minh City. METHODS: A cohort of older patients with bilateral cataract were assessed the week before and one to three months after first eye surgery only or first- and second-eye cataract surgeries. Visual measures including visual acuity, contrast sensitivity, and stereopsis were obtained. Depressive symptoms were assessed using the 20-item Center for Epidemiological Studies-Depression Scale (CES-D). Descriptive analyses and a generalized estimating equations (GEE) analysis were undertaken to determine the impact of cataract surgery on depressive symptoms. RESULTS: Four hundred and thirteen participants were recruited into the study before cataract surgery. Two hundred and forty-seven completed the follow-up assessment after surgery. There was a significant decrease (improvement) of one point in the depressive symptoms score (p = 0.04) after cataract surgery, after accounting for potential confounding factors. In addition, females reported a significantly greater decrease (improvement) of two points in depressive symptom scores (p = 0.01), compared to males. However, contrast sensitivity, visual acuity, and stereopsis were not significantly associated with change in depressive symptoms scores. First-eye cataract surgery or both-eye cataract surgery did not modify the change in depressive symptoms score. CONCLUSION: There was a small but significant improvement in depressive symptoms score after cataract surgery for an older population in Vietnam.

Driver self-regulation and depressive symptoms in cataract patients awaiting surgery: a cross-sectional study.

BACKGROUND: Cataract is an extremely common visual condition of ageing. Evidence suggests that visual impairment influences driving patterns and self-regulatory behavior among older drivers. However, little is known about the psychological effects of driver self-regulation among older drivers. Therefore, this study aimed to describe driver self-regulation practices among older bilateral cataract patients and to determine the association between self-regulation and depressive symptoms. METHODS: Ninety-nine older drivers with bilateral cataract were assessed the week before first eye cataract surgery. Driver self-regulation was measured via the Driving Habits Questionnaire. Depressive symptoms were assessed using the 20-item Center for Epidemiological Studies Depression Scale. Visual, demographic and cognitive data were also collected. Differences between self-regulators and non self-regulators were described and linear regression modeling used to determine the association between driver self-regulation and depressive symptoms score. RESULTS: Among cataract patients, 48% reported self-regulating their driving to avoid at least one challenging situation. The situations most commonly avoided were driving at night (40%), on the freeway (12%), in the rain (9%) and parallel parking (8%). Self-regulators had significantly poorer contrast sensitivity in their worse eye than non self-regulators (p = 0.027). Driver self-regulation was significantly associated with increased depressive symptoms after controlling for potential confounding factors (p = 0.002). CONCLUSIONS: Driver self-regulation was associated with increased depressive symptoms among cataract patients. Further research should investigate this association among the general older population. Self-regulation programs aimed at older drivers may need to incorporate mental health elements to counteract unintended psychological effects.

Vision, quality of life and depressive symptoms after first eye cataract surgery.

BACKGROUND: Cataract affects not only vision, but also performance of everyday tasks, participation in social activities, quality of life and possibly depression. Depression is a major health issue for older adults. It is estimated that 6%-20% of community-dwelling older Australians experience depression. The aim of this study was to investigate changes in vision-related quality of life and depressive symptoms after first eye cataract surgery and to determine which visual measures affect the change in these outcomes. METHODS: In 2009 and 2010, 99 participants with bilateral cataract were recruited. Visual measures including visual acuity, contrast sensitivity and stereopsis were assessed 1 week before and 12 weeks after first eye cataract surgery. Vision-related quality of life was measured using the 25-item National Eye Institute Visual Function Questionnaire. Depressive symptoms were assessed by the 20-item Center for Epidemiological Studies Depression Scale. Separate regression analyses were undertaken to determine the association between visual measures and changes in vision-related quality of life and depressive symptoms after first eye cataract surgery. RESULTS: Overall, vision-related quality of life improved after first eye cataract surgery. There was a small, non-clinically significant improvement in depressive symptoms after surgery. Improvement in vision-related quality of life after first eye cataract surgery was associated with improved contrast sensitivity in the operated eye (P < 0.001), whereas improvement in depressive symptoms after surgery was associated with improved stereopsis (P = 0.032). CONCLUSIONS: Contrast sensitivity and stereopsis, but not visual acuity, were significant factors affecting improvement in vision-related quality of life or depressive symptoms after first eye cataract surgery.

Maternal and foetal outcomes among pregnant women hospitalised due to interpersonal violence: a population based study in Western Australia, 2002-2008.

BACKGROUND: Interpersonal violence is responsible for more ill-health and premature death in women under the age of 45 than other preventable health conditions, but findings concerning the effects of violence during pregnancy on both maternal and foetal health have been inconsistent. METHODS: A retrospective population-based cohort study was undertaken using linked data from the Hospital Morbidity Data Collection and the Western Australian Midwives' Notification System from 2002 to 2008. The aim was to determine the association between exposure to interpersonal violence during pregnancy and adverse maternal and foetal health outcomes at the population level. RESULTS: A total of 468 pregnant women were hospitalised for an incident of interpersonal violence during the study period, and 3,744 randomly selected pregnant women were included as the comparison group. The majority of violent events were perpetrated by the pregnant women's partner or spouse. Pregnant Indigenous women were over-represented accounting for 67% of all hospitalisations due to violence and their risk of experiencing adverse maternal outcomes was significantly increased compared to non-Indigenous women (adjusted odds ratio 1.53, 95% CI 1.21 to 1.95, p = 0.01). Pregnant women hospitalised for an incident of interpersonal violence sustained almost double the risk for adverse maternal complications than the non-exposed group (95% CI 1.34 to 2.18, p < 0.001). The overall risk for adverse foetal complications for pregnant women exposed to violence was increased two-fold (95% CI 1.50 to 2.76, p < 0.001). CONCLUSIONS: The risk of adverse health outcomes for both the mother and the baby increases if a pregnant woman is hospitalised for an incident of interpersonal violence during pregnancy.

Changes in driving performance after first and second eye cataract surgery: A driving simulator study.

INTRODUCTION: This study investigated the separate impact of first eye and second eye cataract surgery on driving performance, as measured on a driving simulator. METHOD: Forty-four older drivers with bilateral cataract aged 55+ years, awaiting first eye cataract surgery participated in a prospective cohort study. They completed a questionnaire, visual tests and a driving simulator assessment at three time points: before first eye, after first eye, and after second eye cataract surgery. Generalized Estimating Equation Poisson or linear regression models were undertaken to examine the change in four driving outcomes of interest after adjusting for cataract surgery and other potential confounders. RESULTS: The rate of crashes/near crashes decreased significantly by 36% (incidence rate ratio (IRR) 0.64, 95% CI 0.47-0.88, p = 0.01) after first eye surgery and 47% (IRR 0.53, 95% CI 0.35-0.78, p < 0.001) after second eye surgery, compared to before first eye cataract surgery, after accounting for confounders. The rate of crashes/near crashes also decreased with better contrast sensitivity (IRR 0.69, 95% CI 0.48-0.90, p = 0.041). A separate model found that time spent speeding 10 kilometers per hour or more over the limit after second eye surgery was significantly less (0.14 min, p = 0.002), compared to before first eye surgery, after accounting for confounders. As contrast sensitivity improved, the duration of speeding also decreased significantly by 0.46 min (p = 0.038). There were no statistically significant changes in lane excursions or speed variation. Practical applications: The findings highlight the importance of timely first and second eye cataract surgery to ensure driver safety, especially as older drivers wait for second eye cataract surgery. It also provides further evidence that contrast sensitivity is probably a better predictor of driving ability in older drivers with cataract than visual acuity, the measure on which driver licensing requirements are currently based, and should also be used when assessing fitness to drive.

Risk factors for unsafe events involving a motor vehicle for group riders (cyclists): A naturalistic case-crossover study.

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.

Impact of the Rural Intersection Active Warning System (RIAWS) on driver speed: A driving simulator study.

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.

Defining exclusive breastfeeding in Australia.

Exclusive breastfeeding for the first 6 months of life is recommended as the optimal way to feed infants. This paper reviews the measurement of exclusive breastfeeding in Australian studies over the past 10 years. Only half the studies identified that claimed to measure exclusive breastfeeding used a definition consistent with the World Health Organisation. Three studies used 24-h or 7-day recall indicators that have been shown to produce overestimations of the prevalence of exclusive breastfeeding. Measurement of exclusive breastfeeding with a valid and consistent definition is vital for monitoring rates and trends, for comparison between different studies and countries and to reach conclusions on various health benefits. Any future measurement of exclusive breastfeeding in Australia should use the World Health Organisation definition and the 24 h recall study design should not be used for this purpose.

The impact of first and second eye cataract surgeries on falls: a prospective cohort study.

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.

Green tea and stroke prevention: emerging evidence.

BACKGROUND: Stroke is a leading cause of morbidity and mortality in many countries. Green tea is a simple and inexpensive beverage that is showing promise in the prevention of several diseases, including stroke. However, epidemiological studies examining the preventive effects of tea on stroke have generated inconsistent results. OBJECTIVE: To review the emerging evidence for green tea in stroke prevention. METHODS: Published articles were located by searching the PubMed, ProQuest, CINAHL and other databases, using the keywords 'tea' and 'stroke' with no restriction on publication date. Reference lists of identified articles were also searched for relevant publications. RESULTS: Two published epidemiological studies on green tea reported positive findings. A large number of studies have also proposed biological mechanisms by which tea or tea components may reduce the stroke risk. Additional studies are required from a variety of populations, assessing duration and different types of tea consumption on subtypes of stroke to provide further evidence. CONCLUSION: Green tea is a safe and cheap beverage. Its consumption should be encouraged because it could potentially serve as a practical method for stroke prevention.

Determinants of the occupational environment and heavy vehicle crashes in Western Australia: A case-control study.

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.

Do older drivers with bilateral cataract self-regulate their driving while waiting for first eye cataract surgery?

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.

Bilateral cataract, crash risk, driving performance, and self-regulation practices among older drivers.

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.

Gender differences in recurrent mental health contact after a hospitalization for interpersonal violence: Western Australia, 1997 to 2008.

Interpersonal violence and mental illness are significant public health issues. This study aimed to determine gender differences in risk factors for recurrent mental health contacts after a hospitalization for interpersonal violence in Western Australia between 1997 and 2008. This population-based retrospective cohort study used linked hospital morbidity data and mental health records to identify individuals who were hospitalized due to interpersonal violence and had recurrent mental health contacts following hospitalization. A total of 1,969 individuals had a first-ever mental health contact after their index hospitalization for violence. The most common reasons for a mental health contact after interpersonal violence hospitalization were anxiety and/or depression (n = 396, 20.1%), neurotic disorders (n=338, 11.8%), schizophrenia (n=232, 11.8%), and psychoactive substance use (n = 206, 10.5%). Different risk factors for recurrent contact with mental health services emerged for males and females. For males, factors significantly associated with increased risk of recurrent mental health contacts included advancing age and not being married. However, for females, type of violence, Indigenous status, age, and living in rural or remote areas affected the risk of recurrent mental health contacts, whereas marital status did not. These findings have implications for the targeting of mental health prevention programs tailored specifically for males and females affected by violence.

Obstructive sleep apnea, health-related factors, and long distance heavy vehicle crashes in Western Australia: a case control study.

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.

A longitudinal cohort study of the impact of first- and both-eye cataract surgery on falls and other injuries in Vietnam.

AIM: Little information exists on the impact of cataract surgery on falls and other injuries in Vietnam. The aim of this study was to determine the impact of first and both eye cataract surgery on the number of falls and other injuries among bilateral cataract patients in Ho Chi Minh City, Vietnam. MATERIALS AND METHODS: A longitudinal cohort study was conducted involving 413 bilateral cataract patients aged 50+ years. Participants were assessed at three time points: 1 week before, 1-3 months after, and 1 year after first-eye cataract surgery. Visual measures (visual acuity, contrast sensitivity and stereopsis) were taken, and self-reported falls and injury data were collected. A multilevel longitudinal Poisson regression model was used to investigate change in the number of falls after surgery. RESULTS: The risk of falls decreased by 78% (incidence-rate ratio [IRR] 0.22, 95% confidence interval [CI] 0.06-0.77; P=0.018) in the year after cataract surgery for participants who had first-eye surgery only and 83% (IRR 0.17, 95% CI 0.04-0.69; P=0.012) for participants who had the second eye operated on compared to before surgery. The risk of falls was three times higher for females than males (IRR 3.13, 95% CI 1.53-6.40; P=0.002). Improved binocular contrast sensitivity was also associated with a decrease in falls (IRR 0.40, 95% CI 0.17-0.97; P=0.042). The prevalence of other injuries also decreased after cataract surgery. CONCLUSION: Cataract surgery reduced the number of falls and other injuries in Vietnam. Contrast sensitivity may be important for ophthalmologists to consider when prioritizing patients for surgery and assessing their fall risk.