Background: Assessing people's ability to drive has become a public health concern in most industrialized countries. Although age itself is not a predictive factor of an increased risk for dangerous driving, the prevalence of medical conditions that may impair driving increases with age. Because the implementation of a screening for unsafe driving due to medical conditions is a public health issue, its usefulness should be judged using standardised criteria already proposed for screening for chronic disease. The aim of this paper is to propose standardised criteria suitable to assess the scientific validity of screening for unsafe driving due to medical conditions, and identify potential issues to be clarified before screening can be implemented and effective.
Objective: To estimate the association between past medical contacts and the risk of vehicle collision in a population of older drivers from the province of Quebec, Canada. Design: Case-crossover study. Setting: Quebec. Participants: 111 699 older drivers involved in at least one vehicle collision between January 1988 and December 2000. Main outcome measures: For each driver, the risk of having a vehicle collision while exposed and not exposed to a medical contact was compared. Separate conditional logistic regression analyses were conducted for all drivers and in four diagnostic-specific subgroups. Results: The study found a weak but statistically significant increased risk of all collisions being associated with a medical contact within 1 month before the collision, for all drivers (OR = 1.10, 95% CI 1.08 to 1.11) and for drivers with diabetes (OR = 1.07, 95% CI 1.03 to 1.11). Conclusion: Older drivers who have a collision are more likely to have been in contact with a physician shortly before the collision. These findings suggest that there might be an opportunity to detect medical conditions that put older drivers at higher risk of collision; however, further research is needed to assess the potential effectiveness and practical modalities of screening. B y 2030, one-quarter of the population in the member countries of the Organization for Economic Co-operation and Development will be aged 65 years and older.
Because of the expected difficult application and cost of road tests and annual screening by clinicians, the most acceptable strategy from public health, clinical, and individual points of view is likely to be no screening.
A599sensus, the assessment of a third investigator was requested. Results: Bariatric surgery showed to be effective and safe in reducing glycated hemoglobin levels, fasting blood glucose levels as well as the augmenting the chances of remission of type II diabetes in obese patients. ConClusions: However, the variability in the magnitude of the results indicated the need for new data from the 18 ongoing clinical trials. In other words, the technology "bariatric surgery" is efficacious as a whole, but there is a high variability in the treatment effect, depending of surgical technique.
PDB13A Cross-seCtionAl stuDy on insulin treAtments AnD GlyCemiC Control in tyPe 2 DiABetes in FrAnCe, itAly, GermAny, uK AnD sPAin
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