Using Serial Trichotomization to Determine Fitness to Drive in Medically At-Risk Drivers.

IMPORTANCE: Clinical tests that identify fit and unfit drivers with 100% sensitivity and specificity would reduce uncertainty and improve efficiency of occupational therapists performing comprehensive driving evaluations (CDEs). OBJECTIVE: To examine whether serial trichotomization of clinical tests predicts pass-fail outcomes with 100% sensitivity and specificity in a sample of medically at-risk drivers and in drivers with and without cognitive impairment (CI) referred for a CDE. DESIGN: Retrospective data collection and analysis of scores on the Montreal Cognitive Assessment; Trail Making Test, Part A and Part B; and the Useful Field of View® Subtests 1 to 3 and outcomes on the CDE (pass-fail or indeterminate requiring lessons and retesting). Receiver operating characteristic curves of clinical tests were performed to determine 100% sensitivity and specificity cut points in predicting CDE outcomes. Clinical tests were arranged in order from most to least predictive to identify pass-fail and indeterminate outcomes. SETTING: A driving assessment clinic. PARTICIPANTS: Among 142 medically at-risk drivers (M age = 69.2 yr, SD = 14.1), 66 with CI, 46 passed and 39 failed the CDE; 57 were indeterminate. OUTCOMES AND MEASURES: On-road pass-fail outcomes. RESULTS: Together, the six clinical tests predicted 62 pass and 49 fail outcomes in the total sample; 21 pass and 34 fail outcomes in participants with CI; and 58 pass and 14 fail outcomes in participants without CI. CONCLUSIONS AND RELEVANCE: Serial trichotomization of clinical tests increases the accuracy of making informed decisions and reduces the number of drivers undergoing unnecessary on-road assessments. Plain-Language Summary: Clinical tests and their cut points that identify fit and unfit drivers vary substantially across settings and research studies. Serial trichotomization is one method that could help control for this variation by combining clinical test scores showing 100% sensitivity and specificity to identify pass (fit drivers) and fail outcomes (unfit drivers) and to reduce the number of drivers undergoing unnecessary on-road assessments.

Developing the Driving and Dementia Roadmap: a knowledge-to-action process.

OBJECTIVES: Despite three decades of research, gaps remain in meeting the needs of people with dementia and their family/friend carers as they navigate the often-tumultuous process of driving cessation. This paper describes the process of using a knowledge-to-action (KTA) approach to develop an educational web-based resource (i.e. toolkit), called the Driving and Dementia Roadmap (DDR), aimed at addressing some of these gaps. DESIGN: Aligned with the KTA framework, knowledge creation and action cycle activities informed the development of the DDR. These activities included systematic reviews; meta-synthesis of qualitative studies; interviews and focus groups with key stakeholders; development of a Driving and Dementia Intervention Framework (DD-IF); and a review and curation of publicly available resources and tools. An Advisory Group comprised of people with dementia and family carers provided ongoing feedback on the DDR's content and design. RESULTS: The DDR is a multi-component online toolkit that contains separate portals for current and former drivers with dementia and their family/friend carers. Based on the DD-IF, various topics of driving cessation are presented to accommodate users' diverse stages and needs in their experiences of decision-making and transitioning to non-driving. CONCLUSION: Guided by the KTA framework that involved a systematic and iterative process of knowledge creation and translation, the resulting person-centered, individualized and flexible DDR can bring much-needed support to help people with dementia and their families maintain their mobility, community access, and social and emotional wellbeing during and post-driving cessation.

Do motorcycle helmets reduce road traffic injuries, hospitalizations and mortalities in low and lower-middle income countries in Africa? A systematic review and meta-analysis.

BACKGROUND: Studies in Africa have examined the association between helmet use and injury prevention, however, there has been no systematic review to synthesize the literature within an African context nor has there been any meta-analysis examining the effect of helmet use on injury prevention. METHODS: The review was performed in accordance with the Joanna Briggs Institute for Systematic Reviews. Articles were searched using several databases (e.g. CINAHL, OVID Medline) and select gray literature (e.g. TRID) sources. Articles were included if they were quantitative studies published in English between 2000 and 2019 and examined the association between motorcycle helmet use with head injuries, hospitalizations, and deaths in low- and lower-middle income countries in Africa with comprehensive motorcycle helmet laws. A meta-analysis was performed using pooled effect sizes assessing the impact of helmet use on reducing head injuries. RESULTS: After screening 491 articles, eight studies met the inclusion criteria. Helmet use ranged from 0 to 43%. The mean age of being involved in a crash was 30 years with males being two times more likely to be involved in motorcycle crashes than females. Drivers (riders) were more likely to be involved in a crash, followed by passengers and then pedestrians. Helmet use reduced injury severity and provided an 88% reduction in serious head injuries (OR 0.118, 95% CI: 0.014-0.968, p = 0.049). CONCLUSIONS: In our study, helmet usage significantly reduced the likelihood of fatal head injuries. African countries with no helmet laws should consider adopting helmet use policies to reduce severe head related injuries from motorcycle crashes.

Examining the Association Between Alcohol Consumption and Health Conditions in Community Dwelling Older Adults.

The Canadian low-risk drinking guidelines were developed for adults, however, the applicability to older adults was not considered in the development of the guidelines. The objectives of this study were to: (1) to examine alcohol use in community dwelling older males and females using the current Canadian guidelines; (2) to test lower limits of alcohol use on various health factors; and (3) to determine health factors associated with high-risk drinking in older males and females. Data on community dwelling older adults (aged 65 +) was used from the Canadian Injury Prevention Survey (n = 2274). Descriptive statistics and comparative analysis were used to compare alcohol consumption categories. Logistic regressions were performed to examine the relationships between health factors and alcohol consumption categories. 70% of the sample reported having at least one drink per week; 4.5% of males and 6.8% of females were high-risk drinkers according to the current guidelines. There were no significant associations between the current alcohol categories with demographics, behavioral risk factors or health conditions. Using the new guidelines, 21% of males and females were classified as high-risk drinkers, respectively. Diabetes and having an illness or disability before retirement was protective of high-risk drinking in males while having diabetes and poorer physical health was protective of high-risk drinking in females. The prevalence of high-risk drinkers is dependent on what alcohol classifications are used. Further studies are needed to determine the causal relationships between health-related factors and alcohol using standardized definitions of alcohol consumption.

"What Is Right for Me, Is Not Necessarily Right for You": The Endogenous Factors Influencing Nonparticipation in Medical Assistance in Dying.

Access to medical assistance in dying (MAID) is influenced by legislation, health care providers (HCPs), the number of patient requests, and the patients' locations. This research explored the factors that influenced HCPs' nonparticipation in formal MAID processes and their needs to support this emerging practice area. Using an interpretive description methodology, we interviewed 17 physicians and 18 nurse practitioners who identified as non-participators in formal MAID processes. Nonparticipation was influenced by their (a) previous personal and professional experiences, (b) comfort with death, (c) conceptualization of duty, (d) preferred end-of-life care approaches, (e) faith or spirituality beliefs, (f) self-accountability, (g) consideration of emotional labor, and (h) future emotional impact. They identified a need for clear care pathways and safe passage. Two separate yet overlapping concepts were identified, conscientious objection to and nonparticipation in MAID, and we discussed options to support the social contract of care between HCPs and patients.

"I Am Okay With It, But I Am Not Going to Do It": The Exogenous Factors Influencing Non-Participation in Medical Assistance in Dying.

Medical assistance in dying (MAID) processes are complex, shaped by legislated directives, and influenced by the discourse regarding its emergence as an end-of-life care option. Physicians and nurse practitioners (NPs) are essential in determining the patient's eligibility and conducting MAID provisions. This research explored the exogenous factors influencing physicians' and NPs' non-participation in formal MAID processes. Using an interpretive description methodology, we interviewed 17 physicians and 18 NPs in Saskatchewan, Canada, who identified as non-participators in MAID. The non-participation factors were related to (a) the health care system they work within, (b) the communities where they live, (c) their current practice context, (d) how their participation choices were visible to others, (e) the risks of participation to themselves and others, (f) time factors, (g) the impact of participation on the patient's family, and (h) patient-HCP relationship, and contextual factors. Practice considerations to support the evolving social contact of care were identified.

Predictors of self-rated oral health in Canadian Indigenous adults.

OBJECTIVES: The purpose of this study was to: (1) compare oral health indicators between Indigenous adults and the general population and (2) examine the predictors of poor self-rated oral health in the Indigenous population. METHODS: Data from the 2017-2018 cycle of the Canadian Community Health Survey was used and included 943 Indigenous and 20,011 non-Indigenous adults. Independent variables included demographic information, lifestyle behaviours, dental concerns and care utilization, and transportation access. The dependent variable was self-rated oral health. A logistic regression was performed to determine predictors of poor self-rated oral health. RESULTS: More than half of the Indigenous sample were aged between 35 and 64 years (57.3%); 57.8% were female. Compared to the general population, the Indigenous group were significantly more likely to have no partner, have less post-secondary education, and have an income of less than $40,000. Almost a fifth of the Indigenous sample self-rated their oral health as poor (18.5%) compared to 11.5% in the general population. Indigenous participants reported significantly poorer general health, had poorer oral care practices, and lifestyle behaviours than the general population (all p < .001). Indigenous adults having poor self-rated oral health was predicted by poorer general health, being a smoker, male, bleeding gums, persistent pain, feeling uncomfortable eating food, avoiding foods, and not seeking regular dental care. CONCLUSIONS: There are many predictors of poor self-rated oral health, many of which are preventable. Providing culturally adapted oral health care may improve the likelihood of Indigeneous adults visiting the dentist for preventative care.

Impact of limited rest areas on truck driver crashes in Saskatchewan: a mixed-methods approach.

BACKGROUND: Long-haul truck drivers (LHTDs) suffer from long work hours often resulting in fatigue. Although several studies have reported that fatigue can contribute to crashes, no study has identified the location and patterns of fatigue-related crashes and solicited truck driver feedback on potential mitigation strategies. The purpose of this study is 1) to map the location of fatigue-related crashes and 2) examine the perceptions of truck drivers concerning fatigue-related crashes. METHODS: Using databases from the Saskatchewan Government Insurance, information on LHTD demographics, crashes and their causes, as well as crash location was analyzed. All fatigue-related crashes were then documented and mapped. Additionally, we interviewed 67 LHTDs (mean age = 53.0 ± 12.9; range 23-89; 95% were men) asking questions about fatigue, access to truck stops/rest areas, and provided recommendations for improvement. All interviews were subsequently analyzed using thematic analyses. RESULTS: On average, there were 20 fatigue-related crashes per year over the 10-year period. Fatigue-related crashes were common across Saskatchewan, however, there was a concentration of crashes along major roadways between major cities. There was a significant association between crashes with age and experience. Despite many LHTDs being fatigued, there was a lack of truck stops/rest areas along highway routes. LHTDs suggested having access to truck stops/rest areas 250-400 km apart with running water and washrooms available. CONCLUSIONS: Additional truck stops and rest areas are needed in Saskatchewan to ensure LHTDs have more opportunities for rest to reduce fatigue in general, as well as to reduce the risk of fatigue-related crashes.

Health Comparisons Between Truck Drivers and the General Population Using the Canadian Community Health Survey.

BACKGROUND: This study examined and compared risk factors and health conditions of truck drivers compared with the general Canadian population. METHODS: This study used the Canadian Community Health Survey consisting of 991 male truck drivers and 29,958 male respondents of the general population. RESULTS: Compared with the general population, truck drivers were older, less educated, had lower incomes, worked more hours, and were more likely to be widowed/separated/divorced. In addition, truck drivers had significantly higher rates of cardiovascular disease and obesity and were more likely to be sedentary, smoke, drive when fatigued, and eat unhealthy compared with the general population. CONCLUSIONS: Multicomponent interventions are needed to address the poor lifestyle practices of truckers to reduce the high rates of morbidity.

Evaluating medically at-risk drivers: a survey of assessment practices in Canada.

BACKGROUND: Assessing medical fitness to drive (FTD) can include both off- and on-road testing, although consistency of practice is unclear. PURPOSE: To examine actual practices being used to assess FTD at driver assessment centres (DACs) across Canada. METHOD: Surveys e-mailed to 90 DACs were returned by 47 assessors. FINDINGS: The majority of respondents (89%) were occupational therapists. Assessors reported doing an average of eight FTD assessments per month (range = I to 40) at an average cost of $366 (SD = $225; range = $40 to $985). Referrals came from physicians (96%), other health professionals (70%), and licensing authorities (66%). Clients with stroke, dementia, traumatic brain injury, mild cognitive impairment, and multiple sclerosis composed 62% of estimated caseloads. Assessments took 3 hr on average (range = 1.24 to 4.5 hr); 64% reported they always took clients on road regardless of clinic results. IMPLICATIONS: Evidence-based guidelines for training and assessment are clearly needed given the inconsistency in practice.

Driving Errors Predicting Pass/Fail On-Road Assessment Outcomes Among Cognitively Impaired Older Drivers.

Older drivers with cognitive impairment (CI)/dementia make significantly more driving errors than healthy controls; however, whether driving errors are predictive of pass/fail outcomes in older drivers with CI/dementia are unclear. This study determined the driving errors that predicted failing an on-road assessment in drivers with CI. We retrospectively collected comprehensive driving evaluation data of 80 participants (76.1 ± 9.3 years) from an Ontario driving assessment center. Adjustment to stimuli (area under the curve [AUC] = 0.88), lane maintenance (AUC = 0.84), and speed regulation errors (AUC = 0.85) strongly predicted pass/fail outcomes. Worse performance on the Trails B (time) and Useful Field of View® (Subtest 2, Subtest 3, and risk index) were significantly correlated with adjustment to stimuli (p < .05), lane maintenance (p < .05), and speed regulation errors (p < .05). Adjustment to stimuli, lane maintenance, and speed regulation errors may be critical indicators of failing an on-road assessment in older drivers with CI. Prioritizing these errors may help identify at-risk drivers.

Body Mass Index and Waist Circumference Correlates With Lifestyle and Health in Long-Haul Truck Drivers.

INTRODUCTION: This study examined and compared the association between body mass index (BMI) and BMI with waist circumference (WC) on lifestyle measure and health outcomes in Canadian long-haul truck drivers (LHTDs). METHODS: Two hundred LHTDs completed a survey on diet and physical activity, and participated in objective measures of height, weight, WC, and blood pressure. RESULTS: More than half of the sample was classified as obese (57%). Body mass index risk was significantly associated with poorer health ( P < 0.05), increased systolic and diastolic blood pressure, increased body fat ( P < 0.001), and sleep apnea ( P < 001). When BMI + WC was used, additional significant associations were observed with age, years of experience, eating breakfast, and hypertension and malignancy. CONCLUSION: Body mass index + WC is a more sensitive measure in assessing cardiometabolic risk in LHTDs than using BMI alone.

An Agenda for Advancing Research and Prevention at the Nexus of Work Organization, Occupational Stress, and Mental Health and Well-Being.

Work characteristics and worker well-being are inextricably connected. In particular, the characteristics of work organization shape and perpetuate occupational stress, which contributes to worker mental health and well-being outcomes. Consequently, the importance of understanding and addressing connections between work organization, occupational stress, and mental health and well-being-the focus of this Special Issue-increasingly demand attention from those affected by these issues. Thus, focusing on these issues in the long-haul truck driver (LHTD) sector as an illustrative example, the purpose of this commentary is as follows: (1) to outline current research approaches and the extant knowledge base regarding the connections between work organization, occupational stress, and mental health; (2) to provide an overview of current intervention strategies and public policy solutions associated with the current knowledge base to protect and promote worker mental health and well-being; and (3) to propose a two-pronged agenda for advancing research and prevention for workers during the 21st century. It is anticipated that this commentary, and this Special Issue more broadly, will both echo numerous other calls for building knowledge and engaging in this area and motivate further research within complementary current and novel research frameworks.

Clinical Tests Predicting On-Road Performance in Older Drivers with Cognitive Impairment.

Background. The Trail Making Test Part B (Trails B) and Useful Field of View® (UFOV) can predict on-road outcomes in drivers with cognitive impairment (CI); however, studies have not included drivers referred for comprehensive driving evaluations (CDEs), who typically have more severe CI. Purpose. We determined the predictive ability of Trails B and UFOV on pass/fail on-road outcomes in drivers with CI (Montreal Cognitive Assessment <26) referred for CDEs. Method. Retrospective data collection from two driving assessments centers (N = 100, mean age = 76.2 ± 8.8 years). Findings. The Trails B (area under the curve [AUC] = .70) and UFOV subtests 2 (AUC = .73) and 3 (AUC = .76) predicted pass/fail outcomes. A cut-point ≥467 ms on UFOV subtest 3 better-predicted pass/fail outcomes with 78.9% sensitivity and 73.5% specificity. In comparison, a cut-point ≥3.58 min on Trails B had lower sensitivity (73.7%) and specificity (61.8%). Implications. The UFOV subtest 3 may be more useful than the Trails B for predicting pass/fail outcomes in drivers with more severe CI referred for CDEs.

Evidence-based review on epilepsy and driving.

OBJECTIVE: The aim of this study was to synopsize the evidence on predictors of crashes and driving status in people with epilepsy (PWE). METHODS: Evidence-based review of the published English literature was the method used. We searched various databases and extracted data from 16 (of 77) primary studies. On the basis of American Academy of Neurology criteria, we assigned each study a class of evidence (I-IV, where I indicates the highest level of evidence) and made recommendations (Level A: predictive or not; Level B: probably predictive or not; Level C: possibly predictive or not; Level U: no recommendations). RESULTS: For PWE, the following characteristics are considered useful: For identifying crash risk, epilepsy (level B) and short seizure-free intervals (≥3 months) (Level C) are not predictive of motor vehicle crash (MVC). For self/proxy-reported crash risk, epilepsy surgery (Level B), seizure-free intervals (6-12 months) (Level B), few prior non-seizure-related crashes (Level B), and regular antiepileptic drug adjustments (Level B) are protective against crashes; seizures contribute to MVCs (Level C); mandatory reporting does not contribute to reduced crashes (Level C). No recommendations for reliable auras, age, and gender (Level U), as data are inadequate to make determinations. For self-reported driving or licensure status, employment and epilepsy surgery are predictive of driving (Level C); there are no recommendations for antiepileptic drug use, self-reported driving, gender, age, receiving employment benefits, or having reduced seizure frequency (Level U). CONCLUSION: Limitations, that is, heterogeneity among studies, examining the English literature from 1994 to 2010, must be considered. Yet, this is the first evidence-based review to synopsize the current PWE and driving literature and to provide recommendation(s) to clinicians and policy makers. Class I studies, matched for age and gender, yielding Level A recommendations are urgently needed to define the risks, benefits, and causal factors underlying driving performance issues in PWE.

Associations between clinical tests and simulated driving performance in persons with epilepsy.

People with epilepsy (PWE) may experience seizures that constitute a risk to road safety. Consequently, many states have instituted restrictions, such as being seizure-free for intervals of 3 to 12 months, before driving can be resumed. However, 30% of drivers with recurrent seizures still drive despite having a restricted license. As a result of recurrent and uncontrolled seizures, PWE may have impairments in motor, visual and cognitive abilities, as well as impaired driving performance. No studies to date have prospectively examined factors associated with driving performance in PWE. The primary objective of this study was to determine which tests, from a clinical battery, are correlated with driving errors in PWE using a simulator. The sample consisted of 16 drivers with epilepsy (mean age 44.3±12.0; 63% women) recruited from the epilepsy monitoring unit at the University of Florida. All participants completed a clinical battery of cognitive, visual and motor tests, as well as a 35-minute drive on a simulator. Significant correlations emerged between: visual acuity with visual scanning (r=.69, p<.01) and adjustment to stimuli (r=.60, p<.05); contrast sensitivity with lane maintenance (r=-.54, p>.05), vehicle position (r=-.61, p>.05) and total number of errors (r=-.72, p>.01); and useful field of view scores (subtest 2) with visual scanning (r=.57, p>.05) and vehicle position (r=.63, p>.05). Limitations and future implications are addressed. The preliminary findings suggest visual and visual-cognitive tests are associated with driving errors in a simulated driving environment.

Themes associated with exercise adherence in persons with Parkinson's disease: a qualitative study.

ABSTRACT The purpose of this study was to examine motivators important to exercise adherence in a group of older adults with Parkinson's disease (PD). Four participants with PD completed a 6-week hydrotherapy program, followed by participation in a focus group along with their caregivers (n = 4) to examine motivators that were important to exercise adherence. A semi-structured focus group was transcribed verbatim and analyzed using content analysis to identify common patterns and themes. Multiple themes were found that were important to exercise adherence. Constant reassurance and support from the exercise leader was a primary theme for remaining enrolled in an exercise program. Exercising in a group environment and social interaction with other persons with PD were also the themes. Perceived changes in physical ability increased participants' confidence and motivation to continue to exercise. The findings suggest that the perceived needs of PD exercise participants can be influenced and addressed by exercise leaders, provide opportunities to improve physical function, and support social interaction. Future exercise programs should be designed to provide a venue where the symptoms of PD are not a deterrent to exercise participation.

Health and Safety Practices and Perceptions of COVID-19 in Long-Haul Truck Drivers.

OBJECTIVE: To examine long-haul truck drivers (LHTD) perceptions of COVID-19 and their use of health and safety practices. METHODS: 146 LHTD completed an online survey to collect data on their experiences with COVID-19. Data were analyzed using descriptive and inferential statistics, and thematic analysis for open-ended responses. RESULTS: LHTD were aged from 22 to 79 years (mean age 48.1 ±â€Š11.8); 82.2% were men. Almost half of the sample were not concerned about COVID-19. Those not concerned were significantly less likely to employ health and safety practices (eg, wearing masks, social distancing), were less educated and healthier. They also perceived COVID-19 to not be real or a serious threat to their health. CONCLUSIONS: Tailored education approaches are needed to provide evidence-based data on COVID-19 risks and complications.

The Impact of COVID-19 on the Work Environment in Long-Haul Truck Drivers.

OBJECTIVE: To describe and compare the working conditions of long-haul truck drivers (LHTD) before and during the Coronavirus (COVID-19) pandemic and to assess the perceptions of LHTDs on accessing food, restrooms, and parking. METHODS: An online survey was disseminated between August 2020 and March 2021 to various trucking organizations across Canada to collect data on health and wellness during COVID-19. Data were analyzed using descriptive and inferential statistics, and thematic analysis for open-ended responses. RESULTS: The sample included 146 LHTD (mean age 48.1 ±â€Š11.8; 82.2% were men). Participants reported issues with finding parking, washrooms, and food. Compared with before COVID-19, LHTD worked significantly more hours and consumed more caffeine; and more than 50% reported being fatigued. CONCLUSIONS: Improving the working conditions of LHTD is critical to support their health and wellbeing, both during and after the pandemic.

Psychotherapeutic Interventions for Dementia: a Systematic Review.

BACKGROUND AND OBJECTIVES: While a range of psychotherapeutic interventions is available to support individuals with dementia, comprehensive reviews of interventions are limited, particularly with regard to outcomes related to adjustment and acceptance. The current review assesses studies that evaluated the impact of various forms of psychotherapeutic interventions on acceptance and adjustment to changing life circumstances for older adults with cognitive impairment. RESEARCH DESIGN AND METHODS: A systematic search of PubMed, PsycINFO, and CINAHL databases was conducted, restricted to articles published in English within the last 16 years (from 2003 to 2019). Twenty-four articles were identified that examined the effects of psychotherapeutic interventions on outcomes related to acceptance and adjustment which included internalizing symptoms, quality of life, self-esteem, and well-being. Fifteen studies examined interventions targeted towards individuals with cognitive impairment, while nine studies also targeted their caregivers. RESULTS: Interventions that impacted outcomes related to acceptance and adjustment (e.g., adaptation, depressive symptoms, helplessness, self-esteem, and quality of life) varied in their theoretical approach, which incorporated elements of cognitive behavioural therapy (CBT), problem-solving therapy, psychotherapy, reminiscence therapy, interpersonal therapy, mindfulness-based therapy, and meaning-based, compassion-focused therapy. Among all interventions, reductions in depression were the most commonly reported treatment outcome particularly among interventions that incorporated problem-focused and meaning-based therapies. Mixed findings were reported with regard to outcomes related to helplessness, quality of life, self-esteem, and life satisfaction indices for individuals with cognitive impairment. DISCUSSION AND IMPLICATIONS: There is some support for the effectiveness of psychotherapeutic interventions on improving acceptance and adjustment in older adults with cognitive impairment, particularly with regard to reducing depressive symptoms.