Older driver retraining: An updated systematic review of evidence of effectiveness

Problem and Objective

The number of older drivers who might benefit from driver retraining is growing. A previous review on the effectiveness of older driver retraining included intervention studies up to 2004. The objective was to perform an updated systematic review of the effectiveness of older driver retraining for improving driving-related skills and reducing crash rates.

Method

Articles published from 2004-2008 were grouped according to the intervention provided and outcome studied. Randomized clinical trials (RCTs) were appraised using the Physiotherapy Evidence Database (PEDro) Scale and scored for quality according to their internal validity. Each intervention's effectiveness was then rated and assigned a level of evidence by combining pre- and post- 2004 findings.

Results

Three RCTs and one matched-pairs cohort design met the inclusion criteria. There is strong evidence (Level 1a) that education combined with on-road training improves driving performance and moderate evidence (Level 1b) that it improves knowledge. There is moderate evidence (Level 1b) that physical retraining improves driving performance. There is moderate evidence (Level 1b) that an educational intervention curriculum alone is not effective in reducing crashes.

Summary

The updated evidence on the effectiveness of retraining aimed at older drivers is sufficiently encouraging to merit assertive health promotion actions regarding intervention and program planning.

Impact on Industry

These positive findings warrant a comprehensive plan that has both behavioral and monetary incentives encouraging older driver participation in programs aimed at driver safety.     

Models at the interface between science and society: impacts and options

Within the CLEAR project a new approach to integrated assessment modelling has been developed for the participatory integrated assessment of regional climate change involving citizens' focus groups. The climate change decision problem was structured by focusing separately on climate impacts and mitigation options. The attempt was made to link the different scales of the problem from the individual to the global level. The abstract topic of climate change was related to options on the level of a citizen's individual lifestyle. The option of a low energy society was emphasised in order to embed the climate change decision problem in a wider range of societal concerns. Special emphasis was given to the characterisation and communication of uncertainties. The chosen approach allows different kinds of uncertainties in one framework to be addressed. The paper concludes with a summary of the experience made, and recommendations for the use of models in participatory integrated assessments. This revised version was published online in July 2006 with corrections to the Cover Date.     

Flow injection spectrophotometric determination of methamidophos using online hydrolysis

A new protocol for the online spectrophotometric determination of methamidophos has been developed. The method is based on online hydrolysis of methamidophos, and the resulting hydrolyzed product is reacted with sodium nitroproside to form a colored complex. The calibration curve is linear over the concentration range of 0.5–20 μgml^?–?1, with a molar absorptivity of 2.5×10⁴ L mol^?1 cm^?1. The method is fast and reproducible with a sample throughput of 90 samples/h. The method is successfully applied to formulations and real samples.     

Microbial degradation and impact of Bracken toxin ptaquiloside on microbial communities in soil

The carcinogenic and toxic ptaquiloside (PTA) is a major secondary metabolite in Bracken fern (Pteridium aquilinum (L.) Kuhn) and was hypothesized to influence microbial communities in soil below Bracken stands. Soil and Bracken tissue were sampled at field sites in Denmark (DK) and New Zealand (NZ). PTA contents of 2.1 +/- 0.5 mg g(-1) and 37.0 +/- 8.7 mg g(-1) tissue were measured in Bracken fronds from DK and NZ, respectively. In the two soils the PTA levels were similar (0-5 microg g(-1) soil); a decrease with depth could be discerned in the deeper B and C horizons of the DK soil (weak acid sandy Spodosol), but not in the NZ soil (weak acid loamy Entisol). In the DK soil PTA turnover was predominantly due to microbial degradation (biodegradation); chemical hydrolysis was occurring mainly in the uppermost A horizon where pH was very low (3.4). Microbial activity (basal respiration) and growth ([3H]leucine incorporation assay) increased after PTA exposure, indicating that the Bracken toxin served as a C substrate for the organotrophic microorganisms. On the other hand, there was no apparent impact of PTA on community size as measured by substrate-induced respiration or composition as indicated by community-level physiological profiles. Our results demonstrate that PTA stimulates microbial activity and that microorganisms play a predominant role for rapid PTA degradation in Bracken-impacted soils.     

Comparison of organochlorine compound concentrations in colostrum and mature milk

Human breast milk represents the best choice for the nutrition of infants. It is often used for monitoring human exposures to environmental chemicals. Uniquely suited to meet human biological needs, breast milk composition, especially fat content, changes significantly with time from delivery. With the aim to compare the concentration of organochlorine compounds (OCs) in colostrum versus mature milk, we obtained samples of fourth-fifth day postpartum milk (colostrum) and day-14 postpartum milk (mature milk) from 12 women enrolled in the project "Early Childhood Development and PCB Exposure in Slovakia". The concentrations of selected organochlorine pesticides and congeners of polychlorinated biphenyls (PCBs) were measured using gas chromatography with electron capture detection and reported on lipid adjusted basis. No significant differences were found between organochlorine levels in colostrum and those in mature milk samples. A very close correlation was found between the concentrations of organochlorine compounds in colostrum and mature milk (Spearman correlation coefficient r=0.94-0.98 for PCBs, and r=0.85-0.99 for organochlorine pesticides, p<0.001 for all compounds). The present study concludes that the use of colostrum samples provides a close estimate of the child's exposure to OCs in the early neonatal period and demonstrates that, despite the lower fat content, colostrum specimens are adequate to conduct OC analyses.     

Investigations of chemical fraction of Co and Ni in industrial fly ash and mobility of metals in environmental conditions

The quantitative evaluation of chemical fraction of Co and Ni in the industrial fly ash by methods of five step sequential extraction was carried out in order to characterize metal mobility in environmental conditions. The research involved (i) water-soluble (pH=7), (ii) acid-soluble (pH=5), (iii) oxide, (iv) sulfide and (v) residue metal fractions. It was discovered, that the total extraction of the studied metals from fly ash to solutions take place in the following quantities Co - 35.5 and Ni - 153.0mgkg(-1). The investigations of chemical fractions proved that the subject metals occur mainly in fly ash as: oxide (Co - 7.0, Ni - 28.5mgkg(-1)) and residue (Co - 11.5, Ni - 42.5mgkg(-1)) as well as sulfide (Co - 8.5, Ni - 46.5mgkg(-1)). Low concentrations of metals for water-soluble fraction (Co - 0.7, Ni - 1.2mgkg(-1)) and acid-soluble fraction (Co - 4.5, Ni - 23.5mgkg(-1)) were observed. The fractions of Co and Ni leachable from the ash in environmental conditions contain: 24.0% (Co) and 23.3% (Ni) of metal total amount in the industrial fly ash. The obtained mobility parameter of Co and Ni can be applied to estimate the concentration increase of mobile and hardly mobile forms of these metals in soil polluted with the ash.     

Differential responses of the freshwater wetland species Juncus effusus L. and Caltha palustris L. to iron supply in sulfidic environments

Sulfur pollution can lead to serious problems in freshwater wetlands, including phosphorus eutrophication and sulfide toxicity. We tested the effects of anaerobic iron-rich groundwater discharge in fens, simulated by iron injection, on two characteristic species (Juncus effusus and Caltha palustris) in a sulfidic environment. Biomass production of C. palustris roots showed an optimum response to the combined addition of iron and sulfide, with highest values at intermediate concentrations of both substances. Iron deficiency apparently occurred at low iron concentrations, while at high iron concentrations, growth was decreased. For J. effusus, in contrast, no toxic effects were found of both iron and sulfide. This could be explained by larger radial oxygen loss (ROL) of J. effusus and could not be explained by differences in phosphorous concentrations. The results of our experiments confirm that iron-rich groundwater discharge has the potential to affect vegetation composition through toxicity modification in sulfidic environments.     

Using data linkage to assess the impact of motorized recreational vehicle-related injuries in Ohio

Problem

Motorized recreational vehicle (MRV)-related injuries can result in severe medical and financial consequences. The objective of this study was to describe the epidemiology, and clinical and financial impact of MRV-related injuries in Ohio.

Method

Probabilistically linked statewide Emergency Medical Services (EMS) and hospital (inpatient and emergency department) data for 2003 and 2004 were examined. Record pairs with a MRV-related E-code (E821-E823, E825) were included in this study.

Results

There were 2,893 patients with MRV-related injuries, who had linked EMS and hospital records, resulting in more than $15 million in hospital charges and 1,921 inpatient days of hospitalization. The male-to-female ratio was nearly 4:1, and 19% were younger than 16. Almost 82% of cases were not wearing a helmet; there was a trend of decreasing helmet use with increasing age. Mean (SE) inpatient hospital charges and length of stay (LOS) were $22,218 ($1,290) and 3.8 (0.2) days, respectively. The mean (SE) Injury Severity Score (ISS) for inpatients was 9.2 (0.4). Individuals injured on a street/highway were 3.20 times more likely to sustain an ISS ≥ 16 (95% CI: 1.03, 9.88; p = 0.044) and 3.05 times more likely to sustain a traumatic brain injury (TBI) (95% CI: 1.17, 7.94; p = 0.024) than those who were injured at a place designated for sport or recreation. Children aged 12 to 15 and young adults aged 16 to 25 were 2.47 and 2.14 times more likely, respectively, to sustain a TBI than adults aged 36 or older (aged 12 to 15: 95% CI: 1.13, 5.38; p = 0.024; aged 16 to 25: 95% CI: 1.26, 3.64; p = 0.005). Higher ISS was associated with both higher total charges (p < 0.001) and longer LOS (p < 0.001).

Discussion

This study demonstrates that MRV-related injuries are an important public health problem in Ohio, with a substantial clinical and financial impact.

Impact on Industry

Enactment and enforcement of statewide MRV safety legislation and training of MRV users offer valuable opportunities to prevent these costly injuries.     

Coverage of motor vehicle crashes with injuries in U.S. newspapers, 1999-2002

Problem

The aims of the study were to evaluate information on motor-vehicle crashes with injuries provided in newspaper reports and to assess the frequency of thematic and episodic reporting of motor-vehicle crashes.

Method

The study used Fatal Analysis Reporting System (FARS) derived variables to code a nationally representative sample of U.S. newspaper reports of motor-vehicle crashes from 1999-2002. A total of 473 newspaper reports of motor-vehicle crashes with injuries were included. Information on the crash event, people involved, and vehicles was extracted. The reports were coded for episodic and thematic news framing.

Results

A majority of newspaper reports used episodic framing. The majority of reports included information on the type of crash, but characteristics about people and vehicles were rarely reported.

Discussion

Lack of information in newspapers makes them an incomplete source from which to influence public perceptions and attitudes.

Impact on industry

This provides an opportunity for news print media to improve public health content.

Impact on industry

Newspapers represent an important source of public information; they are, however, an incomplete source [Voight, B., Lapidus, G., Zavoski, R., & Banco, L. (1998). Injury reporting in Connecticut newspapers. Injury Prevention, 4, 292-294.; Baullinger, J., Quan, L., Bennett, E., Cummings, P., & Williams, K. (2001). Use of Washington state newspaper for submersion injury surveillance. Injury Prevention, 7, 339-342]. To increase the accuracy of information provided to the public through media sources, there is a need for increased communication between public health professionals and reporters.The results of this study raise concerns about the contents of motor-vehicle crash information provided in newspapers and suggest that newspapers do not provide information to allow public perception to be in accord with the importance of motor-vehicle crash injuries and health promoting actions to reduce risk of injury. More balanced and detailed information in newspapers would provide an opportunity for news print media to improve public health programs and public perception about the impact of motor-vehicle crashes on safety for all.