The Association between Visual Abilities and Objectively-Measured Driving Space, Exposure, and Avoidance among Older Drivers.

http://deepblue.lib.umich.edu/bitstream/2027.42/193078/2/The-Association-Between-Visual-Abilities-and-Objectively-Measured-Driving-Space-Exposure-and-Avoidance-among-Older-Drivers.pdfPublished versio

Improving Safe Mobility: An Assessment of Vehicles and Technologies among a Large Cohort of Older Drivers

Evidence suggests that older driver safety may be improved by good vehicle maintenance, in-vehicle advanced technologies, and proper vehicle adaptations. This study explored the prevalence of several measures of vehicle maintenance and damage among older drivers through inspection of their vehicles. We also investigated the prevalence of in-vehicle technologies and aftermarket adaptations. Vehicle inspections were conducted by trained research staff using an objective, standardized procedure. This procedure, developed by a multidisciplinary team of researchers, was based on a review of inspection checklists used by automobile dealerships and the project team's expertise. The study used baseline data from vehicles of 2988 participants in the multi-site Longitudinal Research on Aging Drivers (LongROAD) study. Among this cohort, vehicles were well maintained, had little damage, and contained a range of advanced technologies but few aftermarket adaptations. Implications of study findings for occupational therapy practice are discussed.http://deepblue.lib.umich.edu/bitstream/2027.42/193077/2/Improving Safe Mobility An Assessment of Vehicles and Technologies among a Large Cohort of Older Drivers.pdfPublished versio

Factors relateed to rapid Deceleration Events among a Large Cohort of Older Drivers.

Studies over the past two decades have attempted to document and understand factors related to crashes involving older drivers to develop more effective countermeasures to reduce the frequency and severity of these crashes. Studies in which vehicle acceleration data can be recorded have begun to explore the relationship between rapid deceleration events (RDEs) and functional abilities among older drivers as a surrogate measure of unsafe driving. Recent naturalistic driving studies with older adults have found differing results using different thresholds to define an RDE. The present study examined the relationship among RDE rates, demographics, visual abilities, cognitive abilities, and driving comfort among a large cohort of older drivers, using two definitions of RDEs—longitudinal deceleration of 0.35 g or greater (RDE35) and longitudinal deceleration of 0.75 g or greater (RDE75). The study utilized objective driving, objective functioning, and reported driving comfort data from 2774 participants of the multi-site AAA Longitudinal Research on Aging Drivers (LongROAD) study. RDE rates for each threshold were calculated per 1000 miles driven. Multivariate regression models with backward elimination were developed to examine how outcome measures were related to RDE rates. Too few RDE75 events were found for meaningful analysis. RDE35 rates were significantly associated with several covariates. RDE35 rates were related to declining functional abilities, but many other factors also played a significant role in the rate of RDE35s among older drivers, diminishing the value of using RDE35 rates as a surrogate measure of driving safety. In addition, because the AAA LongROAD sample was relatively healthy and high functioning, other ability-related covariates may also be significantly related to RDE35s but the lack of variance in these measures in the current study prevented these effects from emerging.http://deepblue.lib.umich.edu/bitstream/2027.42/193072/2/1-s2.0-S1369847819301056-main.pdfPublished versio

Abstract P3-12-10: First 6-month report of the longitudinal PHACS study (<u>P</u>harmacology and <u>H</u>ormonotherapy (HT) for <u>A</u>djuvant breast <u>C</u>ancer (BC) <u>S</u>tudy, NCT01127295)

Abstract Background: BC is a hormone-dependent disease for 75% of pts. HT is used in both adjuvant and metastatic settings for hormone–receptor (HR) positive tumors. In adjuvant situation, a 5-year HT period at least is recommended. Side-effects (SE) frequently alter quality of life and compliance, reducing the well-known benefits in risks of relapses and specific deaths. Underlying mechanisms are well understood for estrogen deprivation-induced events such as hot flashes, but little is known on arthralgia under aromatase inhibitors (AI). So, pharmacogenomics (PG), pharmacokinetics (PK), potential medications interactions are of value to explain individual drugs exposures, possible related side-effects and compliance to treatment. Methods: We performed a prospective, multicenter, longitudinal study registering early clinical outcomes and SE during the first 3 years of adjuvant HT with tamoxifen (T) or AI. All tumors expressed at least one HR (&amp;gt;10%). The choice of HT molecule and one-drug or sequential treatment were left to the investigator. Pts were followed every 6 months with clinical examination by the referent oncologist and PK sampling each time. Biologic research consisted in PG investigations of different genes involved in the PK and pharmacodynamics of T and AI (95 SNPs) at baseline. SE, concurrent medications and compliance were registered by both the pts on a diary card and the physician. Evaluation was done only on new occurrence or increased grade of symptoms. Results: This first report focuses on characteristics of the population and the results after the 6 first months of treatment. Between June 2010 and October 2014, 23 centers recruited 2000 pts. 23 were excluded leaving 1977 fully evaluable women; 879 (44%) started with T, 1098 (55%) with AI (554 letrozole (L), 390 anastrozole (A), 154 exemestane (E)). 56% of them had previously received chemotherapy, 96% radiotherapy and 8% trastuzumab. Main characteristics were well balanced between the 2 classes of drugs; T was given mainly for pre- or perimenopausal pts. Most frequent co-morbidities were hypertension (8% T, 31% AI) and dyslipidemia or diabetes (T 11%, AI 26%). To note, almost 30% of pts described arthralgias at entrance and 37% had hot flashes. At 6 months, 122 pts (6%; 43 T, 79 AI) had stopped treatment mainly for toxicity (11 T; 12 AI), progression or death (7 T; 4 IA), personal reasons (15 T; 37AI); 4 asked for changing T and 52 AI (equally for the 3 drugs). All these events were significantly more frequent for AI pts (p=0.042) and with E within the AI class (p&amp;lt;0.001). Main changes in onset or increased intensity of symptoms concerned hot flushes with all drugs (30%), asthenia (20%), insomnia (20%), weight gain (17%), arthralgias (15% for T, 30% for AI), thrombotic events (24 of which 11 with T). 3 grade3 SAE HT-related were reported. Biological data are reported in 2 other abst. (M. White-Koning. abst.#850248, F. Thomas, abst.#851525). Conclusions: These preliminary data on the first 6-months exposure to HT on adjuvant setting in the real-life confirm early rates of withdraws and toxicities. Longer follow-up and subsequent PK analysis should help to understand persistent side-effects and reasons for non-compliance to adjuvant HT. Citation Format: Roché H, Venat-Bouvet L, Debled M, Jacot W, Suc E, Dalenc F, Molnar-Stanciu D, Dohollou N, Franck D, Ferrer C, Laharie-Mineur H, Lavau-Denes S, Massabeau C, Mauries V, Robert J, Pinguet F, Marquet P, Evrard A, Chatelut E, Filleron T. First 6-month report of the longitudinal PHACS study (Pharmacology and Hormonotherapy (HT) for Adjuvant breast Cancer (BC) Study, NCT01127295) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-12-10.</jats:p