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PubMed2000

Domestic control of house dust mite allergen in children's beds.

BACKGROUND: House dust mite allergen levels in humid coastal regions of Australia are high, particularly in beds. Because high allergen levels in beds are associated with more severe asthma, reduction of levels may be important for asthma control. OBJECTIVE: We tested the effectiveness of an acaricidal treatment of bedding in combination with occlusive mattress and pillow encasings in reducing allergen levels in children's beds in a community setting. METHODS: A total of 14 beds of children were selected for the active intervention. In each home the bed of a sibling of nearest age was selected as the control. Dust was vacuumed from beds by using a standard protocol, and Der p 1 levels were measured by using ELISA. Adjacent settling dust was collected by using opened Petri dishes. The intervention consisted of encasing mattresses and pillows in occlusive covers and washing all bedding with Acaril, an acaricidal additive. The acaricidal wash was repeated twice in 7 households at 2-month intervals. Control beds were not treated. RESULTS: The mean Der p 1 concentration at baseline was 27.9 microg/g in the active beds and 18.1 microg/g in the control beds. At 4 days after intervention, Der p 1 decreased to 3.2 microg/g and 15.7 microg/g in active and control beds, respectively. The average difference (active minus control) over the first 8-week cycle was 78.5% (P <.0001), and the difference over 3 washing cycles was 125.1% (P <.05). The mean rate of settling Der p 1 adjacent to the actively treated beds decreased from 24.4 ng.m(-2).d(-1) at baseline to 10.0 ng.m(-2).d(-1) after intervention (P <.01). CONCLUSION: A substantial reduction in Der p 1 levels in beds and in airborne dust in a humid region with naturally high house dust mite allergen levels can be achieved and sustained in a community setting with use of occlusive covers and a rigorous washing routine.

Allergens↗
PubMed2005

Reduction of adverse drug events and medication errors in a community hospital setting.

Keys to success in reducing ADEs have included the support of administrative leaders through their visibility and emphasis on safety as an organizational priority, and financial support for safety projects. Administrative participation was also helpful in promoting safety efforts through the reinforcement of expectations when progress was sluggish. The use of rapid cycle change provided enough early success to serve in motivating staff to push ahead. It allowed staff the opportunity to analyze changes, make adjustments, and retest on a slightly larger scale. Other key success factors included the motivation of teams through continual sharing of progress and success stories; celebrations for achievements are held routinely. As an organization, SJMC has shared its success strategies with other organizations and promoted networking with other organizations to determine what strategies have worked elsewhere. This is helpful as it prevents time from being wasted on solutions that have been tried without success. Within the OSF Healthcare System, the following phrase has been adopted in regard to patient safety, "Safety is like peeling an onion; the more you look, the more you find, and each layer makes you cry."

Adverse Drug Reaction Reporting Systems↗
PubMed2004

In-hospital and one-year outcomes of patients with high-risk acute myocardial infarction treated with thrombolysis or primary coronary angioplasty.

BACKGROUND: The aim of this study was to observe the outcomes of high-risk patients with acute myocardial infarction treated with primary angioplasty and intravenous thrombolysis in a community setting. METHODS: A prospective study of the in-hospital and 12-month outcomes was conducted in 17 cardiology centers where primary angioplasty was available, and in 30 where it was not. Three thousand seventy-four patients in the first 12 hours of an evolving infarction were recruited; among these, 2227 patients who met one or more pre-defined criteria of increased risk were included in the study. RESULTS: Thrombolysis and primary angioplasty were respectively performed in 1090 and in 721 patients; 416 patients (18.7%) received no reperfusion treatment. The incidence of the primary combined in-hospital endpoint (death, non-fatal reinfarction and stroke) was similar in patients treated with thrombolysis (9.2%) and with primary angioplasty (10.7%) (odds ratio--OR 1.19, 95% confidence interval--CI 0.86-1.63, p = NS), and was higher (22.6%) in patients receiving no reperfusion treatment as compared to thrombolysis (OR 3.30, 95% CI 2.36-4.63, p < 0.0001). The occurrence of the 12-month endpoint (death, reinfarction, congestive heart failure and recurrent angina) was lower after primary angioplasty than after thrombolysis (26.8 vs 35.0%, OR 0.68, 95% CI 0.55-0.84, p = 0.0003), due to a lower incidence of angina. At multivariate analysis, older age, anterior infarction, Killip class > 1, high heart rate, and low systolic blood pressure on admission were all significantly associated with a higher incidence of both endpoints. The adjusted analysis confirmed that, despite similar in-hospital results after both reperfusion treatments, primary angioplasty was independently associated with better 1-year outcomes (relative risk 0.66, 95% CI 0.56-0.79, p < 0.0001). CONCLUSIONS: In this observation in the community setting, a strategy of primary angioplasty in patients with high-risk myocardial infarction was not better than thrombolysis in terms of mortality or recurrent infarction, but was associated with less angina at 1 year.

Aged↗
PubMed2000

Services for reducing duration of hospital care for acute stroke patients.

BACKGROUND: Stroke patients conventionally receive a substantial part of their rehabilitation in hospital. Services have now been developed which offer patients in hospital an early discharge with community-based rehabilitation (early supported discharge, ESD). OBJECTIVES: The objective of this review is to establish the costs and effects of ESD services compared with conventional services. SEARCH STRATEGY: The Cochrane Stroke Group Specialised Register was searched and supplemented with information from individual trialists. Searching was completed in March 1999. SELECTION CRITERIA: Randomised controlled trials recruiting stroke patients in hospital to receive either conventional care or any intervention which has provided rehabilitation and support in a community setting with an aim of reducing the duration of hospital care. DATA COLLECTION AND ANALYSIS: Two reviewers scrutinised trials and categorised them on their eligibility. Standardised information was then obtained from the primary trialists. Results were analysed for all trials and for two subgroups depending on whether the intervention was provided by a coordinated multidisciplinary team (coordinated ESD team) or not. MAIN RESULTS: Outcome data are currently available for four trials. Patients tended to be a selected elderly group with disability. Overall, the odds ratio (95% confidence interval) for death, death or institutionalisation, death or dependency at the end of scheduled follow up were 0.87 (0.39-1.93), 0.69 (0.36-1.31) and 0.88 (0.49-1. 57) respectively. Apparent benefits more evident in the three trials evaluating a coordinated ESD team. The ESD group showed significant reductions (P<0.001) in the length of hospital stay equivalent to approximately nine days. REVIEWER'S CONCLUSIONS: ESD services provided for a selected group of stroke patients can reduce the length of hospital stay. However, the relative risks and benefits and overall costs of such services remain unclear.

Home Care Services↗
PubMed1999

Stereotactic breast biopsy in a community hospital setting.

Our institution began using a stereotactic core needle breast biopsy system for mammographically detected breast lesions in November 1996. The system consists of a LORAD stereo imaging table and an 11-gauge vacuum-assisted mammotome (Biopsys Medical, Irvine, CA). All biopsies were performed with the combined efforts of a radiologist and a surgeon. Three hundred sixteen biopsies were attempted in 279 patients, with multiple biopsies in 31 patients. Indications included microcalcifications in 52 per cent of patients and a mass in 48 per cent of patients. Biopsy was unsuccessful in 20 patients (6.3%). Pathologic diagnoses included invasive ductal carcinoma (19 patients), invasive lobular carcinoma (2), ductal carcinoma in situ (17), atypical ductal hyperplasia (8), atypical lobular hyperplasia (1), fibroadenoma (40), lymph node (7), and benign (202). Invasive cancer, in situ carcinoma, or atypical hyperplasia was diagnosed in 46 (15.6%) lesions. Thirty-six patients had open biopsies. The core biopsy diagnosis was correct in 27 lesions, unable to be confirmed in six cases and changed in four cases, with three lesions upgraded and one case downgraded. The 11-gauge vacuum-assisted mammotome provides excellent accuracy for diagnosing mammographic abnormalities. A combined effort between radiology and surgical services is an effective way of using the stereotactic biopsy system.

Adult↗
PubMedDate not supplied

Three-year effectiveness of highly active antiretroviral treatment in the Luxembourg HIV cohort.

UNLABELLED: Clinical trials have shown that highly active antiretroviral treatment (HAART) is able to reduce HIV plasma viral loads to undetectable in 70% to 90% of patients and to increase CD4 cell counts. HAART in community settings (i.e., nonclinical trial situations) is reported to be much less effective. STUDY DESIGN: Observational study. PURPOSE: The aim of our study was to evaluate the effectiveness of protease inhibitor (PI)-based HAART in the Luxembourg HIV cohort after 36 months of treatment in previously treated and untreated patients. The secondary aim was to identify surrogate markers associated with long-term virologic and immunologic outcomes. PATIENTS AND METHOD: Seventy-three PI-naive patients, who started on HAART, combining one PI and two nucleoside reverse transcriptase inhibitors (NRTIs),with a follow-up of 3 years, were evaluated with plasma viral load and CD4 cell counts every 3 months and were analyzed retrospectively. Patients who had been treated previously with NRTI (n = 48) were at a more advanced stage of disease. RESULTS: Overall, there was a mean decrease in viral load compared to baseline of -1.89 log RNA copies/mL (SD = 1.40) that persisted at month 36. Sixty-two percent (62%) of patients reached an undetectable viral load (i.e., below 500 copies/mL): 82% and 53% of NRTI-naive and NRTI-experienced patients, respectively (p =.013). CD4 cell counts increased progressively in both groups with a sustained effect (mean increase of 146 cells/mL +/- 241) at month 36. NRTI-naive patients had a mean increase of 257 cells/mL (SD = 305), in contrast to experienced patients who had an increase of 108 cells/mL (SD = 206) at 3 years. Proportions of patients with a CD4 count under 200 cells/mL fell after 3 years for NRTI-naive (from 66% to 43%) and for experienced patients (from 32% to 13%). Predictors of short duration of viral load response were in decreasing order of importance: clinical AIDS, the use of saquinavir hard gel formulation as initial PI, and the number of NRTIs previously used. Viral load response was the only significant predictor of CD4 changes. CONCLUSION: In a community setting, effectiveness of PI-based HAART at 3 years is still achieved for most patients. NRTI-experienced patients have a good long-term response rate even if it is lower than NRTI-naive patients. A poor treatment response is associated with a more advanced stage of disease before HAART is introduced.

Adult↗
PubMed1997

Two-step tuberculin skin testing of injection drug users recruited from community-based settings.

SETTING: Cross-sectional study of drug users recruited from street-based settings in four US cities: Denver, Portland, Oakland and San Francisco. OBJECTIVE: To evaluate responses to two-step tuberculin skin testing among HIV-positive and HIV-negative injection drug users. DESIGN: Subjects were recruited from existing studies of HIV and risk behaviors for tuberculin skin testing. Those with a negative initial tuberculin test were referred for a second skin test 1-3 weeks later. A positive tuberculin test was defined as > or = 10 mm, or > or = 5 mm if the subject was HIV-positive. RESULTS: Of 997 persons receiving an initial tuberculin test, 13% had a positive response. Of 644 persons receiving a second tuberculin test, 8% had a positive response, with rates as high as 14% among those from Oakland and 12% among African Americans. HIV-positive subjects were less likely to have skin test responses > or = 10 mm on the initial test (P = 0.03), or increases between the initial and second test of > or = 10 mm (P = 0.06). CONCLUSION: Boosting occurred in both HIV-positive and HIV-negative injection drug users. Two-step testing should be considered for this population, particularly those on whom repeat tuberculin testing will be performed.

Adult↗
PubMed2002

Serum estradiol level and risk of breast cancer during treatment with raloxifene.

CONTEXT: As endogenous estradiol increases, risk of breast cancer increases. Raloxifene competes with endogenous estrogen for binding to estrogen receptors in breast tissue. A woman's estradiol level may alter the effects of raloxifene on breast cancer and other outcomes. OBJECTIVE: To test the hypothesis that raloxifene reduces breast cancer risk more in women with relatively high estradiol levels than in women with very low estradiol levels. DESIGN: Analysis of the Multiple Outcomes of Raloxifene Evaluation, a randomized, double-blind, placebo-controlled trial conducted from 1994 to 1999. SETTING: One hundred eighty community settings and medical practices in 25 countries including the United States. PARTICIPANTS: A total of 7290 postmenopausal women aged 80 years or younger with osteoporosis who had baseline serum estradiol concentrations measured by a central laboratory using a sensitive assay. Women with a history of breast cancer or estrogen use were excluded. INTERVENTION: Participants were randomly assigned to receive 60 mg/d or 120 mg/d of raloxifene (n = 4843) or matching placebo (n = 2447) for 4 years. MAIN OUTCOME MEASURE: New cases of histopathologically confirmed breast cancer in the treatment and placebo groups, stratified by estradiol levels. RESULTS: In the placebo group, women with estradiol levels greater than 10 pmol/L (2.7 pg/mL) had a 6.8-fold higher rate of breast cancer (3.0% per 4 years; 95% confidence interval [CI], 1.8%-4.1%) than that of women with undetectable estradiol levels (0.6% per 4 years; 95% CI, 0%-1.1%; P =.005 for trend). Women with estradiol levels greater than 10 pmol/L in the raloxifene group had a rate of breast cancer that was 76% (95% CI, 53%-88%) lower than that of women with estradiol levels greater than 10 pmol/L in the placebo group (absolute rate reduction, 2.2% [95% CI, 1.0%-3.5%; number needed to treat = 45]). In contrast, women with undetectable estradiol levels had similar breast cancer risk whether or not they were treated with raloxifene (risk difference, -0.1%; 95% CI, -0.8% to 0.6%; P =.02 for the interaction). In this cohort, treating women with estradiol levels greater than 10 pmol/L with raloxifene for 4 years would have avoided 47% of breast cancer cases. CONCLUSIONS: Measurement of estradiol level by sensitive assay in postmenopausal women identifies those at high risk of breast cancer who may benefit most from raloxifene. If confirmed, this suggests that measuring estradiol and treating women with high estradiol levels could substantially reduce the rate of breast cancer among postmenopausal women.

Aged↗
PubMed2000

Sentinel node staging for cutaneous melanoma in a university-affiliated community care setting.

BACKGROUND: The feasibility of intraoperative lymphatic mapping and sentinel lymphadenectomy (SLND) in settings other than high-volume specialized clinics has been questioned. We sought to determine the feasibility of SLND in a university-affiliated private teaching hospital. METHODS: A multidisciplinary sentinel node program was established to include surgeons, nuclear medicine physicians, and pathologists. Within this program, 79 patients with cutaneous melanoma underwent attempted SLND after cutaneous lymphoscintigraphy (CL), between January 1994 and December 1998. All sentinel nodes were examined by hematoxylin-eosin staining and determined whether negative for evidence metastatic disease by both S-100 and HMB 45 immunohistochemical staining. RESULTS: CL was successful in 77 (97%) of 79 patients. A total of 88 lymphatic basins were found to be at risk for metastatic disease by CL. SLND was not successful in the two patients who did not have a successful CL. Sentinel nodes were identified in all but three patients with the remaining 88 lymphatic basins (technical success, 97%). There was one false negative in this group of patients (approximately 1%). CONCLUSIONS: SLND is a highly accurate way of staging the regional node basin. Our technical success rates and false-negative rates indicate the feasibility of this approach in settings other than high-volume specialty clinics.

Feasibility Studies↗
PubMed1986

New clinical roles for pharmacists: a study of role expansion.

This study assessed the legitimacy of expanded roles for pharmacists with different status audiences. Pharmacy is a profession in transition and is characterized by considerable ambiguity and uncertainty concerning its status as a health care profession. Significant changes have occurred within the profession of pharmacy in the past few decades which have led to loss of function, social power and status. The response of the profession has been a movement toward a patient-oriented, clinical role for pharmacists. Hypotheses concerning level of support for expanded roles were derived from two conflict-based models of professionalization: a power model which focuses on conflict between professions and the central role of power in defining occupational territory; and a process model which focuses on conflict of interest and diversity within a profession and the development of 'segments' which struggle for control of a profession's direction. Data were collected by self-administered questionnaires sent to California pharmacists, physicians and nurses. Respondents were asked to indicate level of support for 20 role activities for pharmacists working in two practice settings (community and hospital). Pharmacy faculty were the most supportive of the clinical role activities, followed by practicing pharmacists, nurses and physicians. Physicians and nurses were more antagonistic toward clinical activities in the community than hospital practice setting, and were most antagonistic toward role activities which require independent judgement or autonomous action relevant to patient care on the part of the pharmacist. Differences were also noted in support for clinical role activities within the pharmacists' group. The effect of experience in working with a clinical pharmacist on support for clinical role activities is also discussed.

Adult↗
PubMed2006

Development of the fear survey for adults with mental retardation.

This paper describes the development of the fear survey for adults with mental retardation (FSAMR) and provides initial evidence of its psychometric properties. The FSAMR was designed to be sensitive to the assessment needs of individuals with mental retardation. The items were developed through open-ended interviews, a review of existing measures, expert input, and pilot testing. The sample consisted of 138 adults with mental retardation (73 from institutional settings and 65 from community settings). Cronbach's alpha internal consistency coefficients were 0.97 for the scale, and above the 0.60 threshold set for the study for all but the acquiescence response set (ARS) subscale. Significant concurrent validity coefficients with anxiety measures were in the moderate range (r=0.32 and 0.40) and are comparable to other similar studies. Implications for using the FSAMR are discussed.

Adolescent↗
PubMed2006

Effects of routine prophylactic supplementation with iron and folic acid on admission to hospital and mortality in preschool children in a high malaria transmission setting: community-based, randomised, placebo-controlled trial.

BACKGROUND: Anaemia caused by iron deficiency is common in children younger than age 5 years in eastern Africa. However, there is concern that universal supplementation of children with iron and folic acid in areas of high malaria transmission might be harmful. METHODS: We did a randomised, placebo-controlled trial, of children aged 1-35 months and living in Pemba, Zanzibar. We assigned children to daily oral supplementation with: iron (12.5 mg) and folic acid (50 mug; n=7950), iron, folic acid, and zinc (n=8120), or placebo (n=8006); children aged 1-11 months received half the dose. Our primary endpoints were all-cause mortality and admission to hospital. Analyses were by intention to treat. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN59549825. FINDINGS: The iron and folic acid-containing groups of the trial were stopped early on Aug 19, 2003, on the recommendation of the data and safety monitoring board. To this date, 24 076 children contributed a follow-up of 25,524 child-years. Those who received iron and folic acid with or without zinc were 12% (95% CI 2-23, p=0.02) more likely to die or need treatment in hospital for an adverse event and 11% (1-23%, p=0.03) more likely to be admitted to hospital; there were also 15% (-7 to 41, p=0.19) more deaths in these groups. INTERPRETATION: Routine supplementation with iron and folic acid in preschool children in a population with high rates of malaria can result in an increased risk of severe illness and death. In the presence of an active programme to detect and treat malaria and other infections, iron-deficient and anaemic children can benefit from supplementation. However, supplementation of those who are not iron deficient might be harmful. As such, current guidelines for universal supplementation with iron and folic acid should be revised.

Anemia, Iron-Deficiency↗
PubMed1998

Elective repeat cesarean delivery vs trial of labor: a comparison of morbidities in a community hospital setting.

Objective: In an attempt to reduce the cesarean delivery rate nationally, many obstetricians are offering a trial of labor to their patients who have had a prior low transverse cesarean delivery. Many studies have demonstrated the success and safety of a vaginal birth after cesarean. However, few studies have actually compared elective repeat cesareans with a trial of labor. Recent articles suggest that the morbidities associated with a failed trial of labor (TOL) may be more serious than that associated with an elective repeat cesarean delivery (RC/D). Our objective was to review and compare the morbidities and complications of repeat elective cesarean delivery versus patients attempting a trial of labor in our institution.Methods and Materials: A retrospective or nonconcurrent cohort study was conducted. Inclusion criteria included all women at our institution who had delivered from July 1993 through March 1997 and had a prior cesarean delivery. Patients were eligible for a trial of labor according to the recommendations of ACOG Practice Patterns. Exclusion criteria were nonvertex presentation, prior classical or T-incision, placenta previa, previous myomectomy, or multiple gestation. The patients were divided into those who underwent an elective repeat delivery and those who consented to a trial of labor. Outcomes studied included major complications (uterine rupture or operative injury) and minor complications (puerperal fever, postpartum hemorrhage requiring transfusion or operative intervention, or abdominal wound infection). Data were ascertained from medical records, the delivery log book, and the Quality Improvement data base. Prior to performing this study, a power analysis was conducted using an alpha of 0.05 and beta of 0.20. The required number in each arm was 2,280 to determine a 50% difference in outcome.Results: There were 1,148 women who had a repeat cesarean delivery during the study time period. Of that, 174 were excluded by the criteria, leaving 973 eligible. There were 1,030 women who underwent a trial of labor. Seven hundred seventy-three women successfully delivered vaginally (75%). The overall maternal morbidity was 2.4%; 0.8% had a major complication and 1.5% had a minor complication. The total complication rate was similar for both the trial of labor group (TOL) and the elective repeat cesarean delivery group (RC/D): 2.33% and 2.57%, respectively. However, major complications were more frequent among those that attempted a trial of labor than those who underwent an elective repeat cesarean delivery; 1.65% versus 0.1% (relative risk 16.08 with a 95% CI of 2.14-120.57; P =.00024). The relative risk for minor complications in the TOL group compared to the RC/D group was 0.28 with a 95% CI 0.12-0.64 (P =.001). Stratified analysis of the TOL group was performed. Compared to the RC/D group, those who failed VBAC had a relative risk for major complications of 56.85 using a 95% CI of 7.45-428.37. The successful VBAC group did not have statistically higher major complication rate (RR = 2.52, CI 0.23-27.74, P =.4).Conclusions: At our institution, there is a trend that major maternal complications are more frequent among those who have a trial of labor compared to those who have an elective repeat cesarean delivery. This trend was even more evident in those who failed a VBAC trial. When VBAC was successful, complications did not seem to be higher than repeat cesarean delivery. Our study did not have the power because of insufficient numbers in each arm. However, data collection is continuing to achieve the power to this study. This prompted us to reconsider the safety for a trial of labor. Perhaps more stringent criteria for selection of VBAC candidates and determination of when a trial of labor should be abandoned need to be defined. Ongoing study is warranted in this area.

Journal Article↗
PubMed2001

The feasibility of a nurse practitioner-led primary health care clinic in a school setting: a community needs analysis.

AIM: The aim of this New Zealand study was to determine the feasibility of establishing a nurse practitioner-led, family focused, primary health care clinic within a primary school environment as a means of addressing the health needs of children and families. A secondary aim was to ascertain whether public health nurses (PHNs) were the most appropriate nurses to lead such a clinic. METHOD: Utilizing a community needs analysis method, data were collected from three sources --known demographic data, 17 key informant interviews and two focus group interviews. Questions were asked regarding the health needs of the community, the perceptions of participants regarding the role of the PHN, and the practicalities of establishing a clinic including the services participants would expect a clinic to provide. Analysis was exploratory and descriptive. RESULTS: Findings included the identification of a wide range of health issues. These included asthma management and control issues, the need to address poor parenting, and specific problems of the refugee and migrant population. Findings also demonstrated that participant understanding of the role of the PHN was less than anticipated and that community expectations were such that for a PHN to lead a primary health care clinic it would be likely that further skills would be required. Outcomes from investigating the practicalities of establishing a nurse practitioner-led clinic resulted in the preparation of a community-developed plan that would serve to address the health needs of children and families in the area the study was undertaken. Services that participants identified as being appropriate included health information, health education, health assessment and referral. CONCLUSION: Overall findings indicated that the establishment of a nurse practitioner-led, family focused, primary health care clinic in a primary school environment was feasible. While a PHN may fulfil the role of the nurse practitioner, it was established that preparation to an advanced level of practice would be required.

Adolescent↗
PubMed2001

Driving cessation: what older former drivers tell us.

OBJECTIVES: To understand why older drivers living in a community setting stop driving. DESIGN: A cross-sectional study within a longitudinal cohort. SETTING: A geographically defined community in southern California. PARTICIPANTS: 1,950 respondents age 55 and older who reported ever being licensed drivers. MEASUREMENTS: A mailed survey instrument of self-reported driving habits linked to prior demographic, health, and medical information. RESULTS: Of the 1,950 eligible respondents, 141 had stopped driving within the previous 5 years. Among those who stopped, mean age was 85.5 years, 65.2% were female, and the majority reported they were in very good (43.4%) or good (34.0%) health. Nearly two-thirds reported driving less than 50 miles per week prior to stopping and 12.1% reported a motor vehicle crash during the previous 5 years. The most common reasons reported for stopping were medical (41.0%) and age-related (19.4%). In bivariate analyses, age and miles driven per week were each associated with cessation (P < or = .001). Medical conditions, crashes in the previous 5 years, and gender did not reach statistical significance at the P < or = .05 level. Logistic regression results found that the number of medical conditions was inversely associated with driving cessation. CONCLUSION: The relationship between medical conditions and driving is complex; while medical conditions were the most common reason given for driving cessation, those who stopped had fewer medical conditions than current drivers. This suggests that a broader measure of general health or functional ability may play a dominant role in decisions to stop driving.

Accidents, Traffic↗