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PURPOSE With the development of poly (ADP-ribose) polymerase inhibitors for treatment of patients with cancer with an altered BRCA1 or BRCA2 gene, there is an urgent need to ensure that there are appropriate strategies for identifying mutation carriers while balancing the increased demand for and cost of cancer genetics services. To date, the majority of mutation prediction tools have been developed in women of European descent where the age and cancer-subtype distributions are different from that in Asian women. METHODS In this study, we built a new model (Asian Risk Calculator) for estimating the likelihood of carrying a pathogenic variant in BRCA1 or BRCA2 gene, using germline BRCA genetic testing results in a cross-sectional population-based study of 8,162 Asian patients with breast cancer. We compared the model performance to existing mutation prediction models. The models were evaluated for discrimination and calibration. RESULTS Asian Risk Calculator included age of diagnosis, ethnicity, bilateral breast cancer, tumor biomarkers, and family history of breast cancer or ovarian cancer as predictors. The inclusion of tumor grade improved significantly the model performance. The full model was calibrated (Hosmer-Lemeshow P value = .614) and discriminated well between BRCA and non- BRCA pathogenic variant carriers (area under receiver operating curve, 0.80; 95% CI, 0.75 to 0.84). Addition of grade to the existing clinical genetic testing criteria targeting patients with breast cancer age younger than 45 years reduced the proportion of patients referred for genetic counseling and testing from 37% to 33% ( P value = .003), thereby improving the overall efficacy. CONCLUSION Population-specific customization of mutation prediction models and clinical genetic testing criteria improved the accuracy of BRCA mutation prediction in Asian patients.

Introduction The ability to drive longer and safely are crucial for many older adults. There is a growing evidence on self-regulatory practices amongst older drivers in developed countries, but limited studies are conducted in developing countries. This study aimed to explore self-regulatory practices amongst older Malaysian car drivers and motorcycle riders. Materials and methods A cross-sectional study was conducted amongst older adults aged 60 years and above residing in two states located in the west coast of Peninsular Malaysia using a self-administered questionnaire. Stepwise regressions were performed to identify for key factors associated with driving/riding self-regulation and crash involvement. Multilevel modelling was conducted to examine the clustering effect of respondents recruited from the two states. Results Six-hundred and thirty-seven respondents completed the questionnaire, with over three-quarters of them still driving/riding at the time of data collection. Physical fitness, behavioural and psychological changes experienced with advancing age were important motivators towards self-regulation. Motorcycle riders were found to be at a higher risk of crash involvement, and they were more prone to cease riding compared to car drivers. Conclusions Self-regulatory practices amongst older car drivers and motorcycle riders were found to be different. As such, there is a need to customise evidenced-based approaches to cater for specific age groups and road users, particularly in a developing country like Malaysia, where motorcycle is often considered as an affordable mode of transport and is largely involved in road traffic crashes.

Introduction There is growing evidence to suggest the importance of self-regulatory practices amongst older adults to sustain mobility. However, the decision to self-regulate driving is a complex interplay between an individual's preference and the influence of their social networks including spouse. To our best knowledge, the influence of an older adult's spouse on their decisions during driving transition has not been explored. Materials and methods This qualitative descriptive study was conducted amongst married older adults aged 60 years and above. All interview responses were transcribed verbatim and examined using thematic approach and interpretative description method. Results A total of 11 married couples were interviewed. Three major themes emerged: [1] Our roles in driving; [2] Challenges to continue driving; and, [3] Our driving strategies to ensure continued driving. Older couples adopted driving strategies and regulated their driving patterns to ensure they continued to drive safely. Male partners often took the active driving role as the principal drivers, while the females adopted a more passive role, including being the passenger to accompany the principal drivers or becoming the co-driver to help in navigation. Other coping strategies include sharing the driving duties as well as using public transportation or mixed mode transportation. Discussion Our findings suggest spouse play a significant role in their partners' decision to self-regulate driving. This underscores a need to recognise the importance of interdependency amongst couples and its impact on their driving decisions and outcomes.

Introduction: The ability to remain safe behind the wheels can become arduous with aging, yet important for sustaining local travel needs. This review aimed to explore safe mobility issues involving older adults and gain a broad understanding of older drivers' self-regulatory driving practices and motivators behind such behavioral changes, including strategies adopted to reduce or cease driving while maintaining safe mobility. Methods: A systematic literature search was performed on 11 online databases for quantitative studies describing self-regulation of driving amongst older adults aged 60 years and above from database inception until December 2018. Data were described narratively and, where possible, data were pooled using random-effects meta-analysis. Results: Of the 1556 studies identified, 54 studies met the inclusion criteria and 46 studies were included in the meta-analyses. All included studies examined car drivers only. Older adults who were single or female were found to be at higher odds of driving cessation. Physical fitness, mental health, social influence, and support systems received by older adults were important driving forces influencing mobility and adjustments made in their travel patterns. Conclusions: Driving self-regulation amongst older adults is a multifaceted decision, impacting mobility and mental health. Therefore, future interventions and support systems should not only create opportunities for retaining mobility for those who have ceased driving, but also promote better psychological and social well-being for regulators and for those who are transitioning from driving to non-driving status. Practical applications: (a) Engage and educate older adults about self-regulation, including strategies that can be adopted and non-car mobility options available. (b) Expand the research focus to explore potential interactions of factors facilitating or hindering the transition process to develop a more comprehensive framework of self-regulation. (c) Encourage ongoing research to formulate, monitor, and evaluate the effectiveness of policies and interventions implemented. (d) Expand the research horizon to explore and understand the perspectives of older adults from developing countries.

A research thesis focusing on self-regulatory driving and riding practices of older car drivers and motorcycle riders from a Malaysian context, an area previously unexplored. It is evident that mobility change is not only viewed as a physical event, but as a multidimensional process that involves behavioural, psychological, and social well-being of older Malaysian adults. As such, it is imperative to customise support systems, including social, infrastructure, and legal support, to cater for specific age groups and road users, particularly in a developing country like Malaysia, where mixed travel modes are common, and motorcycles are largely involved in traffic collisions.

Introduction Much of the research on transportation and safe mobility focuses on older adult's thoughts and feelings on driving transition in high-income countries, but there is limited knowledge on this process and its consequences in low-and-middle-income countries. Moreover, there is very little understanding of the transition process involving other forms of transport, specifically the motorcycle. This study aimed to understand the process of driving/riding cessation involving former car drivers and former motorcycle riders, including the motivations that act as driving forces influencing the decision to cease driving/riding, challenges faced during the transition, and strategies adopted to adjust to life without driving/riding. Methods Older Malaysian adults aged 60 years and above who had ceased driving and/or riding were interviewed and responded to questions relating to their decision to stop driving/riding. All interview responses were transcribed verbatim and examined using a thematic approach to identify the factors contributing to this decision. Results Five themes and 16 sub-themes were identified: [1] being a driver/rider; [2] making the adjustment; [3] making the decision; [4] experiencing multiple losses; and, [5] coping with transition. Physical, psychological, and social factors were important contributors to driving/riding cessation. Motorcycle riders were at higher risk of road crash and ceased more readily than car drivers. Renewing license, transitioning from riding to driving, and utilising multiple alternative means of transportation were unique coping strategies adopted during post-cessation phase. Conclusions The current findings suggest that cessation is a transition outcome of self-regulation and a successful transition requires discovery of safer mobility opportunities beyond driving and riding. These findings provide direction for the development of culturally sensitive policy and interventions by taking into consideration travel mode preferences and distribution in countries with mixed travel modes to assist retiring car drivers and motorcycle riders to maintain mobility and access in safety.

Introduction: Older adults are at a greater risk of injury and death in a motor-vehicle accident. While the ability to drive safely can be challenging with aging, the concept of self-regulation and associated support system have attracted more attention in recent years, especially in developed countries. This review describes the mechanism and summarizes the potential factors that influenced self-regulation of driving amongst older adults to provide new insights into a broader framework for transportation and safe mobility. Methods: We systematically searched 12 online databases for qualitative studies exploring the experiences of older adults aged 60 years and above on their decision to self-regulate their driving. Thematic synthesis was performed to identify elements influencing driving reduction and cessation. The confidence profile of each findings from the meta-synthesis was appraised using the Confidence in the Evidence from Reviews of Qualitative research (CERQual) tool. Results: A total of 17 studies representing views of 712 older adults from four countries were included. Three major themes were identified with each representing a transition phase that can either facilitate or hinder older drivers from ceasing completely or reducing their driving, when transitioning from pre-decision phase to post-cessation phase. Conclusions: Our findings suggest that there is a mismatch between the current traffic collation prevention measures, such as age-specific mandatory license renewal system and travel needs of older adults. As such, it is time for the authorities, researchers, and public from various fields and perspectives to collaborate, sustain, and improve safety and mobility in older adults. Practical applications: Adequate regulations and guidelines from the medical community and legal authorities are warranted to assist older adults and caregivers. Social support (e.g., feedback, assurance, or transportation support) from family members, friends, and healthcare professionals are crucial for a smooth transition. Provision of alternative transportations in rural areas are needed and future interventions should focus on engaging and educating older adults to consider alternative transportation modes for mobility. Age-specific mandatory license renewal procedure can be useful in screening for at-risk groups.

Introduction The Manchester Driver Behaviour Questionnaire (DBQ) can be regarded as one of the well accepted self-report measures of aberrant driver behaviour in more than 20 years. The various factor structures of DBQ had extensively been examined in past studies related to driving behaviour. The objective of this study is to examine the equivalence of the Malay DBQ factor structures in samples of older car drivers and older motorcycle riders in Malaysia. Methods Five hundred respondents were recruited for this study. Respondents were current and former car drivers or motorcycle riders, aged 60 years and above, and resided in Malaysia. All car drivers and motorcycle riders responded to the Malay DBQ either using a paper-form or an online platform via Qualtrics. Results All four factors in the Malay DBQ were found to be internally consistent for both car drivers sample and motorcycle riders sample. Older motorcycle riders perceived lapse items differently compared to older car drivers. Conclusions The four-factor structures of the Malay DBQ were very similar to the original DBQ, but not identical. This study suggested declining cognitive capabilities of older people were likely to be associated with the increasing likelihood of problems with attention.

Purpose of the study This study aims to estimate the burden of road traffic accidents and death among older adults. Design and methods A systematic literature review was conducted on 10 electronic databases for articles describing Road Traffic Accident(RTA) mortality in older adults until September 2016. A random-effects meta-regression analyses was conducted to estimate the pooled rates of road traffic accidents and death. Results A total 5018 studies were identified and 23 studies were included. Most of the reported older adults were aged between 60 and 74 years, with majority being male gender and sustained minor trauma due to Motor-Vehicle Collision (MVC). The overall pooled mortality rate was 14% (95% Confidence Interval, CI: 11%, 16%), with higher mortality rates in studies conducted in North America (15%, 95% CI: 12%, 18%) and older adults admitted to trauma centers (17%, 95% CI: 14%, 21%). Secondary analysis showed that the very elderly adults (aged >75 years) and pedestrians had higher odds of mortality death (Odds Ratio, OR: 2.05, 95% CI: 1.25, 3.38; OR: 2.08, 95% CI: 1.63, 2.66, respectively). Implication A new comprehensive trauma management guidelines tailored to older adults should be established in low and middle-income countries where such guidelines are still lacking.