FEEDBACK trial - A randomised control trial to investigate the effect of personalised feedback and financial incentives on reducing the incidence of road crashes.

BACKGROUND: Road crashes continue to pose a significant threat to global health. Young drivers aged between 18 and 25 are over-represented in road injury and fatality statistics, especially the first six months after obtaining their license. This study is the first multi-centre two-arm parallel-group individually randomised controlled trial (the FEEDBACK Trial) that will examine whether the delivery of personalised driver feedback plus financial incentives is superior to no feedback and no financial incentives in reducing motor vehicle crashes among young drivers (18 to 20 years) during the first year of provisional licensing. METHODS: A total of 3,610 young drivers on their provisional licence (P1, the first-year provisional licensing) will participate in the trial over 28 weeks, including a 4-week baseline, 20-week intervention and 4-week post-intervention period. The primary outcome of the study will be police-reported crashes over the 20-week intervention period and the 4-week post-intervention period. Secondary outcomes include driving behaviours such as speeding and harsh braking that contribute to road crashes, which will be attained weekly from mobile telematics delivered to a smartphone app. DISCUSSION: Assuming a positive finding associated with personalised driver feedback and financial incentives in reducing road crashes among young drivers, the study will provide important evidence to support policymakers in introducing the intervention(s) as a key strategy to mitigate the risks associated with the burden of road injury among this vulnerable population. TRIAL REGISTRATION: Registered under the Australian New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12623000387628p on April 17, 2023.

Personalized driving safety: Using telematics to reduce risky driving behaviour among young drivers.

INTRODUCTION: The role of real-time data capture (via telematics technology) is gathering prominence as a strategy to provide feedback to young drivers about important road safety issues. METHOD: A naturalistic driving study was undertaken to determine whether providing personalized feedback (via a smartphone app) to young provisional drivers aged 17-20 years living in metropolitan and regional Western Australia (WA) reduced their risky driving behavior compared to a control group who did not receive feedback. Speeding over the posted speed limit, harsh decelerations (braking), harsh accelerations and overall driving performance, were recorded continuously using the smartphone app during the 11-week study. Four separate Generalised Estimating Equations (GEE) linear regression models were undertaken after accounting for relevant confounders including driving exposure to determine the difference between the intervention and control group for the 4 driving outcomes obtained from the smartphone app. RESULTS: The study found that there was no significant change in overall driving scores between the intervention and control groups (p = 0.35). However, the overall driving score significantly improved by 0.19 points for young provisional drivers who lived in regional areas compared to those in the metropolitan area (p = 0.05) after adjusting for potential confounders. There was also no significant change in harsh braking scores (p = 0.46) and harsh acceleration scores between the intervention and control groups (p = 0.26) However, harsh acceleration scores improved by 0.37 points for females compared to males (p = 0.04). Lastly, there was no significant change in speed scores between the control and intervention groups (p = 0.72). However, the speed scores of participants who lived in regional WA improved by 0.22 points compared to those in the metropolitan area (p = 0.02). Furthermore, for every 1,000 km travelled, speed scores worsened by -0.08 points (p < 0.01) regardless of group. CONCLUSIONS: The study did not find any statistical difference in the driving outcomes examined; however the treatment effects for feedback were consistently in the expected positive direction. Young drivers in regional WA also improved their speeding scores and overall driving performance scores compared to young drivers in the metropolitan area. Females, also significantly improved their harsh deceleration scores compared to males, regardless of group allocation. These results highlight the use of smartphone telematics as an opportunity to not only enhance the safety of provisional young drivers but also provide data-informed decision making and policy development.

Falls and Physical Activity among Cataract Patients in Vietnam.

PURPOSE: To investigate the relationship between falls, physical activity, and other socio-demographic and visual factors among cataract patients in Ho Chi Minh City, Vietnam. METHODS: A cross-sectional study was conducted between April and November 2018. Patients presenting to two hospitals with age-related unilateral or bilateral cataract, aged ≥50 years, literate, and scheduled for a first-eye cataract surgery were recruited. The International Physical Activity Questionnaires short form was used to measure physical activity. Visual disability score was self-reported using the Catquest-9SF. The number of falls in the last 12 months prior to data collection were self-reported. Visual acuity and contrast sensitivity were measured using standard protocols. RESULTS: A total of 340 patients had complete data, the majority of whom were women (62.4%), living with a spouse (66.5%), had an education level of Grade 5 or below (68.2%), and a monthly income from medium to high (58.5%). Average age was 65.7 years. A total of 135 falls were reported in the last 12 months with 27.6% reporting ≥1 fall and 7.1% ≥2 falls. Persons with high (adjusted Prevalence Ratio (aPR) = 2.4, 95%CI = 1.2, 4.7) and low (aPR = 2.4, 95%CI = 1.2, 4.6) physical activity levels had more falls compared to those with moderate levels. Women (aPR = 1.7, 95%CI = 1.04, 2.7) and those with medium income (aPR = 2.9, 95%CI = 1.2, 6.9) were more likely to fall. Poor binocular logMAR visual acuity with habitual correction (aPR = 2.3, 95%CI = 1.1, 4.6) and poor visual disability scores (aPR = 1.4, 95%CI = 1.02, 2.0) were associated with falling. CONCLUSION: Patients with a moderate level of physical activity were less likely to fall compared to those with low or high levels although this U-shape relationship needs to be further investigated in prospective interventional trials. Men and those with high monthly income, better visual acuity and visual disability score were also less likely to fall. Cataract patients might be advised to maintain a moderate level of physical activity while waiting for surgery. Strategies to prevent falls may also prioritise cataract surgery for women and those with lower income.

A Longitudinal Study Examining Self-Regulation Practices in Older Drivers with and without Suspected Mild Cognitive Impairment.

PURPOSE: Mild cognitive impairment can impact driving performance and self-regulation practices. However, there is little evidence on how cognitive impairment may impact these self-regulation practices over a period of time. Therefore, the aim of this study was to examine changes in the number and type of situations in which older drivers with and without suspected mild cognitive impairment (MCI) self-regulate their driving over a one-year period, after accounting for relevant confounders. PARTICIPANTS AND METHODS: A longitudinal cohort study involving older drivers (65+ years) from metropolitan Western Australia was interviewed by a telephone interview at baseline and one-year follow-up. The Telephone Cognitive Screen (T-CogS) was also administered to determine changes in their cognitive status. The outcome of interest was the number and type of situations older drivers self-regulated their driving. RESULTS: A total of 670 drivers were interviewed at baseline (suspected MCI: n = 227; no cognitive impairment: n = 443) and one-year follow-up (suspected MCI: n = 251; no cognitive impairment: n = 419), which provided 1340 observations. Drivers with suspected MCI increased the number of driving situations in which they self-regulated by 13% over a period of one-year compared with drivers without cognitive impairment (IRR = 1.13, 95% CI = 1.02-1.27, p = 0.025). Specifically, drivers with suspected MCI had 60% increased odds of self-regulating when "making turns across oncoming traffic" compared with drivers without cognitive impairment (unadjusted OR = 1.60, 95% CI = 1.02-2.53, p = 0.041). Other significant factors included being female (IRR = 1.87, 95% = 1.52-2.32, p = 0.001), aged 75+ years (IRR = 1.33, 95% CI = 1.10-1.60, p = 0.003), higher number of comorbidities (1-3 comorbidities: IRR = 1.26, 95% CI = 1.01-1.58, p = 0.040; 4+ comorbidities: IRR = 1.39, 95% CI = 1.08-1.78, p = 0.011), "decreased driving confidence" (IRR = 1.32, 95% CI = 1.10-1.58, p-value = 0.003) and "preference of having someone else drive" (IRR = 1.38, 95% CI = 1.12-1.70, p = 0.003). Having one or more traffic infringements was also associated with a decrease in the number of self-regulated driving situations (IRR = 0.80, 95% CI = 0.67-0.95, p = 0.011). CONCLUSION: Over a one-year period, drivers with suspected MCI increased the number of situations in which they self-regulated their driving compared with drivers without cognitive impairment, particularly when "making turns across oncoming traffic". Future studies should examine whether this increase in the types and number of self-regulated driving situations is enough to compensate for declines in cognition.

The Impact of Cognition and Gender on Speeding Behaviour in Older Drivers with and without Suspected Mild Cognitive Impairment.

PURPOSE: Mild cognitive impairment and gender can impact different aspects of driving performance and behaviour in older drivers. However, there is little evidence on how these may affect naturalistic speeding behaviour. Therefore, the aim of this study was to examine the relationship between speeding events and cognitive status for older male and female drivers. PARTICIPANTS AND METHODS: A naturalistic driving study collected objective driving information over a two-week period using an in-vehicle monitoring device from 36 older drivers with suspected mild cognitive impairment and 35 older drivers without cognitive impairment. The outcome of interest examined was the number of speeding events, defined as travelling 5+ km/h over the posted speed limit for at least a minute. RESULTS: The majority of participants (n=58, 81.69%) did not have a speeding event during the two-week monitoring period. Twenty-three speeding events were recorded among seven drivers with suspected mild cognitive impairment and six drivers without cognitive impairment. The majority of speeding events (82.61%) were by older male drivers and occurred in 60km/h and 70km/h speed zones. The results of the two negative binomial regression models found that in older male drivers, suspected mild cognitive impairment (IRR=7.45, 95% CI=1.53-36.15, p=0.01) was associated with a significantly higher rate of speeding events, while increasing age was associated with a lower rate of speeding events (IRR=0.80, 95% CI=0.64-1.00, p=0.04). For older female drivers, there were no factors significantly associated with the rate of speeding events. CONCLUSION: While the overall number of speeding events were infrequent, suspected mild cognitive impairment was associated with a significant increase in the rate of speeding events for older male drivers, but not for older female drivers. Speeding interventions and injury prevention policy strategies may need to be targeted differently for male and female drivers with mild cognitive impairment.

Changes in driving performance after first and second eye cataract surgery: A driving simulator study.

INTRODUCTION: This study investigated the separate impact of first eye and second eye cataract surgery on driving performance, as measured on a driving simulator. METHOD: Forty-four older drivers with bilateral cataract aged 55+ years, awaiting first eye cataract surgery participated in a prospective cohort study. They completed a questionnaire, visual tests and a driving simulator assessment at three time points: before first eye, after first eye, and after second eye cataract surgery. Generalized Estimating Equation Poisson or linear regression models were undertaken to examine the change in four driving outcomes of interest after adjusting for cataract surgery and other potential confounders. RESULTS: The rate of crashes/near crashes decreased significantly by 36% (incidence rate ratio (IRR) 0.64, 95% CI 0.47-0.88, p = 0.01) after first eye surgery and 47% (IRR 0.53, 95% CI 0.35-0.78, p < 0.001) after second eye surgery, compared to before first eye cataract surgery, after accounting for confounders. The rate of crashes/near crashes also decreased with better contrast sensitivity (IRR 0.69, 95% CI 0.48-0.90, p = 0.041). A separate model found that time spent speeding 10 kilometers per hour or more over the limit after second eye surgery was significantly less (0.14 min, p = 0.002), compared to before first eye surgery, after accounting for confounders. As contrast sensitivity improved, the duration of speeding also decreased significantly by 0.46 min (p = 0.038). There were no statistically significant changes in lane excursions or speed variation. Practical applications: The findings highlight the importance of timely first and second eye cataract surgery to ensure driver safety, especially as older drivers wait for second eye cataract surgery. It also provides further evidence that contrast sensitivity is probably a better predictor of driving ability in older drivers with cataract than visual acuity, the measure on which driver licensing requirements are currently based, and should also be used when assessing fitness to drive.

Driving exposure, patterns and safety critical events for older drivers with and without mild cognitive impairment: Findings from a naturalistic driving study.

OBJECTIVE: The aim of the study is to compare driving exposure, patterns and factors associated with safety critical events between drivers with MCI and a comparison group without cognitive impairment. DESIGN, SETTING, PARTICIPANTS: Naturalistic driving data using an in-vehicle monitoring device were collected from 36 older drivers with MCI and 35 older drivers without cognitive impairment over a two-week period in Western Australia. MEASUREMENTS: Naturalistic driving exposure, patterns (eg. night-time trips, peak-hour trips) and safety critical events (harsh acceleration, harsh braking and harsh cornering). RESULTS: Drivers with MCI had a lower number of safety critical events (mean = 7.20, SD = 11.44) compared to drivers without cognitive impairment (mean = 10.89, SD = 23.30) however, this was not statistically significantly. There were also no statistically significant differences between drivers with and without MCI for measures of driving exposure or any of the driving patterns including weekday trips, night-time trips and trips on highways/freeways. The results of the multivariable modelling found only binocular contrast sensitivity was associated with the rate of safety critical events. For every increase of 0.1 log units in contrast sensitivity (better contrast sensitivity) the rate of safety critical events significantly decreased by 30 % (IRR = 0.70, 95 % CI = 0.50-0.98, p = 0.04). CONCLUSION: Drivers with MCI were found to have similar driving exposure and patterns compared to older drivers without cognitive impairment, however drivers with better contrast sensitivity experienced fewer safety critical events. Future research should consider a longitudinal study design with an extended driving monitoring period and a larger sample with a clinical diagnosis of MCI to assess changes in cognition and its impact on driving.

Risk factors for unsafe events involving a motor vehicle for group riders (cyclists): A naturalistic case-crossover study.

This study aimed to determine the risk factors associated with unsafe events involving a motor vehicle, that occurred while group riding (cycling) in Perth, Western Australia. Naturalistic video footage was collected from 52 group riders and unsafe events identified. A case-crossover study was used to compare the road infrastructure and group behavioural characteristics of 108 case sites where unsafe events occurred to 216 control sites where no unsafe events occurred. After controlling for potential confounding factors, roundabouts increased the risk of an unsafe event compared to midblocks (odds ratio (OR): 3.63, 95% confidence interval (CI): 1.57-8.42, p = 0.003), priority control intersections (OR: 4.36, 95% CI: 1.49-12.76, 0.007) and traffic signal intersections (OR: 5.57, 95% CI: 1.42-21.79, p = 0.014). Raised traffic islands (OR: 2.30, 95% CI: 1.41-3.78, p = 0.001), posted speed limits of ≥60 km per hour (OR: 2.45, 95% CI: 1.55-3.86, p < 0.001) and group rider traffic violations (OR: 2.51, 95% CI: 1.14-5.53, p = 0.022) also significantly increased the risk of an unsafe event. Riding two abreast in the traffic lane (OR: 0.50, 95% CI: 0.32-0.76, p = 0.002) or having all riders in the bicycle lane (OR: 0.14, 95% CI: 0.04-0.51, p = 0.003), significantly reduced the risk of an unsafe event, compared to riding single file in the traffic lane. Simple road infrastructure treatments on popular group riding routes as well as education targeting both group riders and motorists, could reduce unsafe events and promote a safer, more inclusive shared road environment for group riders.

Getting back on the bike: Participation in cycling after a hospitalisation crash.

This study firstly aimed to describe bicyclists' return to cycling after a hospitalisation crash. Secondly, it aimed to determine factors associated with reduced cycling post-crash. A study of 83 cyclists hospitalised due to an on-road crash was undertaken in Perth, Western Australia. Participants completed a questionnaire shortly following the crash and were followed up approximately 12 months after the crash. Injury information was obtained from the WA State Trauma Registry. A binary logistic regression model was used to examine factors associated with 'reduced cycling exposure' at follow-up. Sixty percent of participants had 'reduced cycling exposure' and 40% had 'no reduction in cycling exposure' at follow up. Twenty-two percent of participants had not cycled at all since the crash. Despite 46% reporting fear of crashing/ lack of confidence as a reason for 'reduced cycling exposure', only 7% of all participants had received any counselling. After controlling for confounding factors, those who participated in group riding before the crash (OR: 0.24, 95% CI: 0.08-0.66, p = 0.006) and those who had a 'complete functional recovery' (OR: 0.15, 95% CI: 0.04-0.64, p = 0.011), had lower odds of 'reduced cycling exposure' at follow-up. In addition, those who were not employed full time at baseline had higher odds of 'reduced cycling exposure' at follow up (OR: 3.72, 95% CI: 1.22-11.33, p = 0.021). Provision of psychological services following a bicycle crash may be an important intervention for improving levels of fear and confidence surrounding cycling and assisting cyclists in returning to their pre-crash level of participation. In addition, interventions promoting return to cycling, should be targeted towards non-group riders who cycle for either commuting or recreational purposes.

Identifying the distracting aspects of electronic advertising billboards: A driving simulation study.

The aim of the study was to investigate the impact of digital billboards on driving performance and visual attention. The impact of dwell time, location and content of digital billboards on driving behaviour was also examined. A 3 × 2 × 2 × 2 experimental study was undertaken using a laboratory driving simulator and data analysed using factorial four-way analysis of variance. A total of 96 participants completed the study, ranging in age from 18 to 76 years. On sections of roads containing billboards, participants drove at lower mean speeds (p < 0.001), had more speed variability (p < 0.001), more variability in lane position (p < 0.001), more time spent at high risk headway < two seconds (p = 0.013), more time spent at high risk headway <0.25 s (p = 0.002) and had more visual fixations (p = 0.01), compared to control sections of road with no billboards. Billboards with simple (versus complex) content presented at a long dwell time (60 s versus 40 or 20 s) had the least negative impact on driving outcomes. Billboards with complex content had similar negative effects on driving, regardless of dwell time. In addition, post-mounted roadside billboards (versus bridge mounted) with 60 s dwell times had the least negative impact on driving. While the presence of digital billboards negatively affected driving performance, simple billboard content and longer dwell times were safer. The results of the study will assist in the development of evidence-based guidelines for digital billboards.

Impact of the Rural Intersection Active Warning System (RIAWS) on driver speed: A driving simulator study.

The Rural Intersection Active Warning System (RIAWS) is an innovative road safety treatment designed to slow traffic on major approaches to a high-risk rural intersection when vehicles are turning or crossing into or out of the side roads, thus reducing fatal and serious casualties. A 2 × 2 experimental driving simulation study was undertaken which aimed to determine the impact of signage (RIAWS versus traditional painted) and sign content (80 km/h versus slow down) on drivers' instantaneous speed at rural intersections. The driving simulator assessment was completed by 96 drivers aged between 18 and 80 years with a current WA C class licence (passenger vehicle). This provided a total of 384 observations. The results of a two-way ANOVA found a significant interaction effect between speed signage and sign content (F(1,3) = 11.78, p < 0.001). The RIAWS "80 km/h" sign resulted in significantly lower instantaneous speeds than all other types of signs including RIAWS "slow down signs (p < 0.001), traditional painted "80 km/h" signs (p = 0.023) and traditional painted "slow down" signs (p = 0.001). Overall, the study found that RIAWS "80 km/h" sign and not the RIAWS "slow down" sign provided the most effective option for reducing driver speeds on approach to rural intersections. Further research is needed to determine the most effective placement of the RIAWS "80 km/h" signs and how they perform on curved roads.

Driver Self-Regulation Practices in Older Drivers with and Without Mild Cognitive Impairment.

OBJECTIVE: To assess the impact of cognitive, socio-demographic and driving-related characteristics on self-regulation practices in older drivers with mild cognitive impairment (MCI) (determined by the Telephone Cognitive Screen (T-CogS) score), compared with drivers with no cognitive impairment. DESIGN SETTING PARTICIPANTS: A cross-sectional study collected information from 362 drivers with MCI and 611 drivers with no cognitive impairment, who were aged 65+ years, and were living in Western Australia between November 2018 and February 2019. MEASUREMENTS: Self-reported self-regulation driving practices. RESULTS: The majority of drivers with MCI (62.4%) and those with no cognitive impairment (57.1%) reported self-regulating their driving in at least one situation, in the past three months. The most common situations that both groups of drivers self-regulated in were "driving at night in the rain", "parallel parking", and "driving when raining". Drivers with MCI were only significantly more likely to self-regulate when "making turns across oncoming traffic" and "driving at night". They also had 39% greater odds of self-regulating in at least one driving situation, compared with drivers with no cognitive impairment (OR: 1.39, 95% CI=1.04-1.85, p=0.02). Females also had 2.3 times greater odds of self-regulating (OR=2.34, 95% CI=1.76-3.12, p<0.001). Drivers aged 75+ years had 1.6 times greater odds of self-regulating, compared with drivers aged 65-69 years (OR=1.58, 95% CI=1.12-2.23, p=0.01). CONCLUSION: Older drivers with MCI were more likely to self-regulate their driving, compared to drivers with no cognitive impairment, particularly in complex driving situations. This suggests that some drivers with MCI may be able to recognize their cognitive limitations and adjust their driving accordingly. However, several drivers with MCI, particularly males, did not self-regulate their driving. This highlights the importance of advising patients about the impact of MCI on driving ability, suitable self-regulation strategies, as well as monitoring their driving ability.

Characteristics of the road infrastructure and injurious cyclist crashes resulting in a hospitalisation.

Faced with the current growth and change to Western Australia's road network as well as the promotion and increased uptake of cycling, further investigation into crash, injury and road infrastructure characteristics is necessary. An in-depth study was conducted of 100 cyclists who were injured due to involvement in a crash that occurred on-road and resulted in an admission to a hospital. Information collected included a researcher-administered questionnaire, crash details from the Integrated Road Information System (IRIS), injury information from the State Trauma Registry and a virtual on-line site inspection. Overall, 42 % of crashes involved a motor vehicle and 58 % did not involve a motor vehicle. Twenty-one percent of all crashes involved cyclist loss of control, 18% were crashes with another cyclist, 18% involved hitting an object and 1% involved a pedestrian. . Bicycle crashes were severely under-reported with only 40 percent reported to the Police. Approximately half of crashes occurred at intersections (51 %) and half at midblock (non-intersection) sites (49 %). Fifty-seven percent of crashes that occurred at intersections involved a motor vehicle, whereas only 27% of crashes that occurred at midblocks involved a motor vehicle. The majority of cyclists' injuries were classified as minor according to the Injury Severity Score with the mean number of body regions injured being 4.5 (SD = 2.2). The mean number of days in hospital care was 5.2 days (SD = 5.6, range: 1-33). These findings can be used to guide road infrastructure treatments that reduce the risk of bicycle crashes in Western Australia and insights may inform action in other jurisdictions where cycling is increasing in popularity.

Safer vehicles and technology for older adults.

Objective: The objective of this study was to address the uptake of safer vehicles and in-vehicle technologies among older adults through a better understanding of extent and use of safer vehicles and awareness/acceptance of new vehicle technologies.Methods: Data were collected from a sample of 501 active older drivers (those who drove at least once a week) through telephone surveys.Results: The sample included experienced and active drivers aged between 65 and 92 years (median 73 years). Though two-thirds indicated that safety was a priority in their vehicle choice, other factors such as reliability and vehicle make were more important. There was low awareness of driver assist safety features, particularly among the oldest drivers. Only one-quarter of drivers were receptive to paying extra for safety features, and there was no interest in paying more for driverless vehicles.Conclusions: The findings showed an overall low awareness and acceptance of in-vehicle safety features; however, where there was some awareness, there was greater interest in purchasing vehicles with safety features. More effort should be undertaken to develop and prioritize a set of recommendations to increase use of safe vehicles by older drivers.

Safer cycling and the urban road environment: A case control study.

This study aimed to identify features of the road environment that increased the risk of on-road bicycle crashes in Perth, Australia between 2014-2017. This case-control study used a combination of an in-depth crash study and naturalistic study to compare the road environment characteristics of 100 case (crash) sites and 300 control sites where no crash occurred using conditional logistic regression. For intersection sites, roundabouts (adjusted OR: 2.98, 95% CI: 1.18, 7.56) and traffic lights (adjusted OR: 3.86, 95% CI 1.29, 11.63) significantly increased the risk of a bicycle crash, compared to priority control/uncontrolled intersections. For midblock (non-intersection) sites, roads with an incline (upwards/downwards) significantly increased the risk of a crash (adjusted OR: 3.39, 95% CI: 1.02, 11.22), compared to level roads. This study highlighted the risk of roundabouts, traffic lights and roads with an incline for bicycle crashes. Treatments that reduce vehicle speeds and encourage cyclists to claim the lane at roundabouts, as well as careful road design and road maintenance at traffic lights, may reduce the risk of crashes for cyclists. While it is impossible to remove hills and slopes from the topography, it is possible to select routes to target for bicycle infrastructure which are predominantly level.

Impact of first and second eye cataract surgery on physical activity: a prospective study.

OBJECTIVES: To investigate the impact of first eye and second eye cataract surgery on the level of physical activity undertaken by older adults with bilateral cataract. DESIGN: Prospective cohort study. SETTING: Three public ophthalmology clinics in Western Australia. PARTICIPANTS: Fifty-five older adults with bilateral cataract aged 55+ years, awaiting first eye cataract surgery. OUTCOME MEASURES: The primary outcome measure was participation in moderate leisure-time physical activity. The secondary outcomes were participation in walking, gardening and vigorous leisure-time physical activity. Participants completed a researcher-administered questionnaire, containing the Active Australia Survey and visual tests before first eye cataract surgery, after first eye surgery and after second eye surgery. A Generalised Estimating Equation linear regression model was undertaken to analyse the change in moderate leisure-time physical activity participation before first eye surgery, after first eye surgery and after second eye surgery, after accounting for relevant confounders. RESULTS: Participants spent significantly less time per week (20 min) on moderate leisure-time physical activity before first eye cataract surgery compared with after first eye surgery (p=0.04) after accounting for confounders. After second eye cataract surgery, participants spent significantly more time per week (32 min) on moderate physical activity compared with after first eye surgery (p=0.02). There were no significant changes in walking, gardening and vigorous physical activity throughout the cataract surgery process. CONCLUSION: First and second eye cataract surgery each independently increased participation in moderate leisure-time physical activity. This provides a rationale for timely first and second eye cataract surgery for bilateral cataract patients, even when they have relatively good vision.

The impact of first- and second-eye cataract surgery on motor vehicle crashes and associated costs.

Objective: to evaluate the association between first- and second-eye cataract surgery and motor vehicle crashes for older drivers and the associated costs to the community. Design: retrospective population-based cohort study. Subjects: a total of 2,849 drivers aged 60 years and older who had undergone both first- and second-eye cataract surgery were involved in 3,113 motor vehicle crashes as drivers during the study period. Methods: de-identified data were obtained using the Western Australian Data Linkage System from 1 January 2003 to 31 December 2015. Poisson regression analysis based on Generalised Estimating Equations was undertaken to compare the frequency of crashes in the year before first eye cataract surgery, between first and second eye surgery and 1 year after second eye surgery. Results: first eye cataract surgery was associated with a significant 61% reduction in crash frequency (P < 0.001) and second eye surgery was associated with a significant 23% reduction in crashes (P < 0.001), compared to the year before first eye cataract surgery after accounting for age, gender, marital status, accessibility, socio-economic status, driving exposure and comorbidities. The estimated cost savings from the reduction in crashes in the year after second eye cataract surgery compared to the year before first eye cataract surgery was $14.9 million. Conclusions: first- and second-eye cataract surgery were associated with a significant reduction in motor vehicle crashes, with first eye surgery having the greatest impact. These results provide encouragement for the timely provision of first- and second-eye cataract surgery for older drivers.

The impact of first and second eye cataract surgeries on falls: a prospective cohort study.

PURPOSE: The purpose of this study was to investigate the impact of the first and second eye cataract surgeries on the risk of falls in participants with bilateral cataract and to determine which changes in visual measures are associated with changes in the number of falls throughout the cataract surgery process. PATIENTS AND METHODS: Fifty-five older adults with bilateral cataract aged 55+ years were assessed at three time points during the cataract surgery process, and they completed a falls diary. Two separate generalized estimating equation-negative binomial models were undertaken to assess changes in the number of falls before first eye cataract surgery, between first and second eye surgeries, and after second eye cataract surgery and which changes in visual measures were associated with changes in the number of falls. RESULTS: After adjusting for potential confounding factors, the risk of falls decreased by 54% (incidence rate ratio (IRR) =0.458, 95% CI=0.215-0.974, p=0.04) after first eye cataract surgery only, compared with the period before first eye surgery. The risk of falls decreased by 73% (IRR =0.268, 95% CI =0.114-0.628, p=0.002) after second eye cataract surgery, compared with the period before first eye surgery. Improved binocular visual acuity (IRR =5.488, 95% CI =1.191-25.282, p=0.029) and contrast sensitivity (IRR =0.257, 95% CI =0.070-0.939, p=0.040) were associated with a decrease in the number of falls. CONCLUSION: The study found that first and second eye cataract surgeries reduced the risk of falls among a cohort of bilateral cataract patients with relatively good baseline vision. This suggests that timely first and second eye cataract surgeries could play an important role in reducing the burden due to falls among older adults with cataract.

First and second eye cataract surgery and driver self-regulation among older drivers with bilateral cataract: a prospective cohort study.

BACKGROUND: Driving a car is the most common form of transport among the older population. Common medical conditions such as cataract, increase with age and impact on the ability to drive. To compensate for visual decline, some cataract patients may self-regulate their driving while waiting for cataract surgery. However, little is known about the self-regulation practices of older drivers throughout the cataract surgery process. The aim of this study is to assess the impact of first and second eye cataract surgery on driver self-regulation practices, and to determine which objective measures of vision are associated with driver self-regulation. METHODS: Fifty-five older drivers with bilateral cataract aged 55+ years were assessed using the self-reported Driving Habits Questionnaire, the Mini-Mental State Examination and three objective visual measures in the month before cataract surgery, at least one to three months after first eye cataract surgery and at least one month after second eye cataract surgery. Participants' natural driving behaviour in four driving situations was also examined for one week using an in-vehicle monitoring device. Two separate Generalised Estimating Equation logistic models were undertaken to assess the impact of first and second eye cataract surgery on driver-self-regulation status and which changes in visual measures were associated with driver self-regulation status. RESULTS: The odds of being a self-regulator in at least one driving situation significantly decreased by 70% after first eye cataract surgery (OR: 0.3, 95% CI: 0.1-0.7) and by 90% after second eye surgery (OR: 0.1, 95% CI: 0.1-0.4), compared to before first eye surgery. Improvement in contrast sensitivity after cataract surgery was significantly associated with decreased odds of self-regulation (OR: 0.02, 95% CI: 0.01-0.4). CONCLUSIONS: The findings provide a strong rationale for providing timely first and second eye cataract surgery for older drivers with bilateral cataract, in order to improve their mobility and independence.

Alcohol and non-alcohol-related motor vehicle crashes in Perth, Australia: Do alcohol outlets make a difference?

This study examined the effects of distance from alcohol outlets to motor vehicle crashes across the Perth metropolitan area. A retrospective population-based study was undertaken using measures of alcohol- and non-alcohol-related crashes, and their proximity to alcohol outlets, using a geographic information system. Two logistic regression models were developed with the following outcomes: i) crashes including drivers with BAC ≥ 0.05%, and ii) weekend single vehicle night-time crashes, a surrogate measure of alcohol-related crashes. The surrogate measures of non-alcohol-related crashes for these models were all day-time and single vehicle day-time crashes respectively. The major predictors of alcohol-related crashes were number of on-premise outlets and bottleshops in buffer zones up to 2 km, 2 km-5 km, 5 km-10 km and 10 km-20 km from crashes. The distance from the central business district (CBD) and sociodemographic factors were controlled for. The study included 341,467 crashes that occurred between 2005 and 2015. The highest crash incidence rates occurred in the CBD. The statistical models indicated that crashes with a higher number of on-premise outlets in adjacent buffer zones were more likely to be alcohol-related than non-alcohol-related crashes. Crashes with a higher number of on-premise outlets less than 2 km, 2 km-5 km, 5 km-10 km, and 10 km-20 km from the crashes were significantly more likely to be weekend single vehicle night-time crashes than day-time crashes (OR = 1.014; 95% CI:1.002-1.027, OR = 1.022; 95% CI:1.014-1.029, OR = 1.019; 95% CI:1.014-1.024, and OR = 1.017; 95% CI:1.014-1.020 respectively). There was some evidence that crashes with lower number of bottleshops in adjacent buffer zones were more likely to be alcohol-related crashes, although this was not consistent across both models and all buffer zones. When other predictors were controlled for, alcohol-related crashes were more likely to occur further from the CBD, than in the CBD. Recommendations about the timing and location of roadside alcohol testing are made.