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Older adults rely mostly on driving to accomplish their transportation needs. With age-related functional limitations, most notably cognitive decline and dementia, vision impairment, and arthritis, driving may become more challenging. Seniors may need to find ways to maintain or enhance their driving ability or utilize alternate methods of transportation. Based on recent research and product development, a variety of resources are now available to assist rehabilitation specialists and related healthcare professionals in providing programs and information to their older patients. This article provides a comprehensive listing of programs, Web sites, and informational materials to assist older people in remaining safely mobile later in life. [ABSTRACT FROM AUTHOR]

Background: Elastin is a fibrous protein key to the structure and support of skin as well as other organ tissues. Elastic fibers are located in the skin's dermal layer and make up approximately 2%-4% of the fat-free dry weight of the dermis in the skin of adults. Aging causes the progressive degradation of elastin fibers. Loss of these fibers can cause skin sagging and wrinkling, loss of healthy blood vessels and lung capacity, aneurysms, and Chronic Obstructive Pulmonary Disease (COPD)., Objective: We hypothesized that ellagic acid, a polyphenol, will increase elastin in human dermal fibroblasts (HDF) due to polyphenols' elastin binding properties., Method: We treated HDF's with 2 μg/ml ellagic acid for 28 days to see the elastin deposition in HDF cell cultures. To test this, we treated HDFs with polyphenols ellagic acid for 3, 7, 14 and 21 days. For comparison purposes, we included a group of ellagic acid and retinoic acid since retinoic acid is already in the market for elastin regeneration purposes., Results: When ellagic acid and retinoic acid were introduced together, insoluble elastin and collagen deposition were significantly higher in HDFs compared to other groups., Conclusion: Polyphenols and retinoic acid can improve skin extracellular matrix production of elastin and collagen and may improve skin fine wrinkles.

The objective of this review was to examine the evidence for the link between fatigue and safety, especially in transport and occupational settings. For the purposes of this review fatigue was defined as 'a biological drive for recuperative rest'. The review examined the relationship between three major causes of fatigue - sleep homeostasis factors, circadian influences and nature of task effects - and safety outcomes, first looking at accidents and injury and then at adverse effects on performance. The review demonstrated clear evidence for sleep homeostatic effects producing impaired performance and accidents. Nature of task effects, especially tasks requiring sustained attention and monotony, also produced significant performance decrements, but the effects on accidents and/or injury were unresolved because of a lack of studies. The evidence did not support a direct link between circadian-related fatigue influences and performance or safety outcomes and further research is needed to clarify the link. Undoubtedly, circadian variation plays some role in safety outcomes, but the evidence suggests that these effects reflect a combination of time of day and sleep-related factors. Similarly, although some measures of performance show a direct circadian component, others would appear to only do so in combination with sleep-related factors. The review highlighted gaps in the literature and opportunities for further research., (Copyright © 2009 Elsevier Ltd. All rights reserved.)

Unobtrusive video camera units were installed in the vehicles of 70 volunteer drivers over 1-week time periods to study drivers' exposure to distractions. The video data were coded based on a detailed taxonomy of driver distractions along with important contextual variables and driving performance measures. Results show distractions to be a common component of everyday driving. In terms of overall event durations, the most common distractions were eating and drinking (including preparations to eat or drink), distractions inside the vehicle (reaching or looking for an object, manipulating vehicle controls, etc.), and distractions outside the vehicle (often unidentified). Distractions were frequently associated with decreased driving performance, as measured by higher levels of no hands on the steering wheel, eyes directed inside rather than outside the vehicle, and lane wanderings or encroachments. Naturalistic driving studies can provide a useful supplement to more controlled laboratory and field studies to further our understanding of the effects of all types of distractions on driving safety.

Objectives: Recurrent abdominal pain (RAP) is a common childhood complaint rarely associated with organic disease. Recently, the Pediatric Rome Criteria were developed to standardize the classification of pediatric functional gastrointestinal disorders (FGIDs) using a symptom-based approach. The authors tested the hypothesis that most patients with childhood RAP could be classified into one or more of the symptom subtypes defined by the Pediatric Rome Criteria., Methods: Using a prospective longitudinal design, new patients with RAP (n = 114) were studied at a tertiary care children's medical center. Before the medical evaluation, parents completed a questionnaire about their child, assessing symptoms defined by the Pediatric Rome Criteria., Results: Of the 107 children for whom medical evaluation revealed no organic etiology for pain, 73% had symptom profiles consistent with the Pediatric Rome Criteria for one of the FGIDs associated with abdominal pain (irritable bowel syndrome, 44.9%; functional dyspepsia,15.9%; functional abdominal pain, 7.5%; abdominal migraine, 4.7%), Conclusions: This study provides the first systematic empirical evidence that RAP, originally defined by Apley, includes children whose symptoms are consistent with the symptom criteria for several FGIDs defined by the Rome criteria. The pediatric Rome criteria may be useful in clinical research to (1) describe the symptom characteristics of research participants who meet Apley's broad criteria for RAP, and (2) select patients with particular symptom profiles for investigation of potential biologic and psychosocial mechanisms associated with pediatric FGIDs.

In the U.S. as well as other countries, the number of motorcyclists killed in traffic crashes has risen sharply over the past five years, due in part to the increased popularity of motorcycling among older riders. This paper examines trends in motorcyclist casualties and vehicle registrations from 1990-2002, based on national and state (North Carolina) motor vehicle crash and vehicle registration data. The data show similar patterns of increased fatalities that parallel a growth in motorcycle registrations. Whereas the number of motorcyclists ages 16-24 declined over the 13-year study period, the number of riders ages 35 and older increased. Three years of recent (2000-2002) NC data are examined to identify salient characteristics of the crashes of these older riders. Results are discussed with respect to approaches for mitigating the increase in motorcyclist deaths and injuries.

To document drivers' exposure to potential distractions and the effects of these distractions on driving performance, inconspicuous video camera units were mounted in the vehicles of 70 volunteer subjects. The camera units automatically recorded a closeup view of the driver's face, a broader view of the interior of the vehicle, and the roadway immediately ahead of the vehicle whenever it was powered on. Three hours of randomly selected data per subject were coded based on a taxonomy of driver distractions (talking on cell phone, eating, tuning radio, etc.), contextual variables (whether vehicle stopped or moving, road type, traffic level, etc.) and observable measures of driver performance (eyes directed inside or outside vehicle, hands on or off steering wheel, and vehicle position in travel lane). Results were analyzed descriptively and using nonparametric bootstrap analysis techniques. The most common distractions in terms of overall event durations were eating and drinking (including preparations to eat or drink), distractions inside the vehicle (reaching or looking for an object, manipulating vehicle controls, etc.), and distractions outside the vehicle (often unidentified). Although many of the distractions were also associated with negative driving performance outcomes, further research is needed to clarify their impact on driving safety.

Five years (1995-1999) of national Crashworthiness Data System (CDS) data are analyzed to determine the role of driver distraction in traffic crashes and the specific sources of this distraction. Results show that 8.3 percent of the drivers were distracted at the time of their crash; after adjustment for the large percentage of drivers with unknown distraction status, the percentage rose to 12.9 percent. The most frequently cited sources of driver distraction were persons, objects or events outside the vehicle (29.4% of distracted drivers), adjusting the radio, tape or CD player (11.4%), and other occupants in the vehicle (10.9%). Other specific distractions (moving objects in vehicle, other objects brought into vehicle, adjusting vehicle or climate controls, eating and drinking, cell phones, and smoking) were each cited in only one to four percent of the cases. The likelihood of being distracted and the source of distraction varied by driver age but not by gender. Results are discussed in light of the limitations inherent in the CDS and other crash data, and the need for expanded data collection initiatives.

The purpose of this case-control study was to assess the frequency of the inappropriate diagnosis of reflex sympathetic dystrophy (RSD) in patients who presented with dysfunctional postures of the upper extremity (n = 43). This group of patients with a dysfunctional posture was compared with a randomly selected control group of patients who presented with pain but no dysfunctional posture (n = 88). The patients underwent radiographic evaluation after review of previous medical records and history and physical examination. Patients with dysfunctional postures had a significantly higher frequency (63%) of a previous inappropriate diagnosis of RSD compared with the control group (6%). None of the patients in either group had objective findings consistent with a diagnosis of RSD. Patients presenting with dysfunctional postures of the upper extremity may be misdiagnosed as having RSD and rarely meet the criteria for this diagnosis.

Information on 2558 persons treated for injuries incurred while bicycling or walking was collected from eight hospital emergency departments over approximately a one-year time period. The emergency departments represented a mix of urban and suburban/rural sites in three states--California, New York, and North Carolina. The data were collected on special survey forms and included detailed information about the location of the injury event. Results show that, overall, 70% of the reported bicycle injury events and 64% of the reported pedestrian injury events did not involve a motor vehicle. In addition, 31% of the bicyclists and 53% of the pedestrians were injured in non-roadway locations such as sidewalks, parking lots, or off-road trails. Although pedestrians and bicyclists struck by motor vehicles in the roadway were generally the most seriously injured, they represented less than a third of the reported cases. Increased knowledge of non-roadway and non-motor vehicle pedestrian and bicyclist injury events can contribute to more effective program and countermeasure development to improve pedestrian and bicyclist safety.

More than 50% of patients with a diagnosable psychiatric disorder initially present with somatic symptoms, which often effectively distract the physician from the true illness. Moreover, the occupational setting is ripe for the emergence of psychosocial issues.

Objective: To determine whether older drivers with poorer cognitive and/or visual function drive fewer miles or avoid driving in situations that pose higher crash risks, such as at nighttime, in rush hour traffic, or when weather conditions are bad., Design: A cross-sectional data analysis conducted as part of a larger prospective study., Subjects: A total of 3238 drivers aged 65 and older applying for renewal of their driver's license at one of eight participating North Carolina driver's license offices., Measurements: Subjects were administered a battery of brief tests of cognitive and visual function, which included the Trail Making Test Parts A and B, the Short Blessed Orientation-Memory-Concentration test, and measures of high and low contrast visual acuity, contrast sensitivity, and peripheral vision. Participants were also asked to complete a brief driving survey containing questions about the number of miles they drove and whether they avoided driving under certain conditions, such as after dark or on busy, multi-lane roadways. Driver age and gender were covariates in the analyses., Results: Results of multivariate logistic regression models show a clear pattern of reduced driving exposure--lower annual miles and greater avoidance of high-risk driving situations--associated with lower levels of cognitive and visual function. In general, the prevalence odds of reduced driving exposure were higher for the cognitive function variables than for the visual function variables, and higher for males than for females. Men who scored in the lowest quartile of performance on one of the cognitive tests were six to seven times more likely to report driving fewer than 3000 miles a year than were men scoring in the highest quartile, and women with low scores were one-and-one-half to two times more likely to report driving less than 3000 miles than women with higher scores., Conclusions: While the findings of this study are reassuring, they do not guarantee that all drivers with cognitive and visual impairments are limiting their driving exposure appropriately, and geriatricians and other health professionals should be encouraged to evaluate their patients' cognitive and visual fitness for driving and provide counsel where indicated.

During the summer of 1987, 10,000 color-coded mailback questionnaires that identified belted and unbelted North Carolina drivers were handed out at the 72 sites that constitute the probability sample for determining the statewide belt use rate in North Carolina. By obtaining identifying information to determine the winner of a $500 prize from among the 5,074 respondents, police-reported traffic accident and conviction records from the North Carolina driver history file were linked to the belted and unbelted respondents. Analyses found that drivers who had been observed not wearing seat belts had 35% more accidents and 69% more convictions than did belted drivers in the previous four-year period. Similar findings were obtained from self-reported belt use.

This paper describes the implementation and evaluation of a nonsanction seat belt law enforcement program in two experimental communities of contrasting size in a state with a mandatory belt law. The main ingredients of the program were seat belt "salutes," public information and education, and limited use of inexpensive economic incentives. Driver shoulder belt use data collected before, during, and after the experimental programs, compared to similar data collected in a comparison community, showed the approach to be effective. While standard seat belt enforcement activities without incentives have been shown to be effective, many police departments, especially in smaller communities, are reluctant to make wholesale increases in seat belt citations. Although requiring some additional level of manpower and resources, a nonsanction approach to seat belt law enforcement can provide an alternate way of increasing belt use in these communities.

Management of nailfold deformity is a difficult problem, with only seven documented techniques of reconstruction to date. We report 17 who underwent nailfold reconstruction with use of a one-stage, dorsal rotational flap with full thickness skin graft. Results show increases in range of motion and improved nail appearance.

A previously disabled family member is presented as a psychosocial determinant in the subsequent disability of the patient. Eighty-three disabled patients presented for an independent medical examination of the upper extremity. All were seeking a workers' compensation settlement or continued workers' compensation benefits. Patients were questioned regarding the current disability of any family member(s). Forty-four of the 83 had at least one family member who was disabled and 36 had experienced a traumatic incident or injury resulting in workers' compensation. Forty-seven had no objective impairment. These findings suggest a significant correlation between the "disabled" support system and subsequent disability of the patient (P < .001).

North Carolina motor vehicle crash data for even-numbered years 1974-1988, inclusive, are analyzed in conjunction with North Carolina population, licensed driver, and mileage data to examine trends in motor vehicle crash involvement by driver age, sex, and race. Crash rates per licensed driver are presented along with crash rates per estimated vehicle miles travelled calculated on the basis of induced exposure. Results focus particularly on older drivers. They show that older drivers' representation in the licensed driver population has increased at a greater rate than their representation in either the census or crash involvement populations. These trends are particularly strong for females and for nonwhites. Furthermore, crash rates have declined more for drivers aged 55 and older than for younger drivers. The greatest declines, both in terms of crashes per licensed driver and crashes per estimated miles travelled, have been experienced by drivers age 65 and older, particularly nonwhites. Males show higher overall crash rates per miles travelled than females, but this effect decreases with age and disappears entirely in the oldest age categories. Results are discussed in light of the changing nature of the overall driving population and the cohort of older drivers in particular.

We report a patient with sebaceous gland carcinoma of the finger. Sebaceous gland carcinomas located outside the ocular adnexa are rare, with fewer than 100 cases documented to date. The majority of these arise in the head and neck where sebaceous glands are plentiful. Because this tumor shows no pathognomonic characteristics, accurate histologic evaluation is essential to its diagnosis. Local excision may not be adequate treatment for a sebaceous gland carcinoma of the digit. Ray amputation was the treatment of choice for this patient.

The North Carolina Seat Belt Law required an evaluation of the effectiveness of the act with a report of the findings to the Legislature three years after the law went into effect. This paper addresses changes in statewide belt usage and in occupant injury associated with that law. Observational data collected bimonthly from a probability sample of 72 sites stratified by geographic region, rural/urban location, road type, and time of day show that belt use rose from a baseline rate of 25% to a warning ticket phase rate of 45%. Belt use then reached 78% upon enforcement and is now nearly 64%. Time series analysis showed that statistically significant reductions in percentages of moderate and serious injuries occurred at the beginning of both the warning ticket and the enforcement phases. Forecasts of injuries and deaths were also developed from the time series models and were compared with observed totals. Warning tickets brought about a modest 5.4% reduction in serious injuries; fatalities among occupants covered by the law showed no change. In contrast, the subsequent enforcement phase saw a reduction of 11.6% in fatalities and 14.6% in serious or worse injuries. This represents an estimated annual savings of 131 lives and over 2,300 serious injuries in North Carolina during the 18 months following onset of enforcement.

Bicycle accident and injury data collected by two different samples of North Carolina hospital emergency rooms during the summers of 1985 and 1986 are examined and compared with state police-reported bicycle accident data for the same time periods. Of the 649 emergency room treated bicyclists, 62% were children aged 5-14 and 70% were male. Nineteen percent of the riders suffered moderate or worse injuries (AIS greater than or equal to 2), and 6% were hospitalized. In contrast, less than half of the police-reported accidents involved riders under 15 years of age, 85% of the riders were male, and two-thirds suffered moderate or worse injury. Whereas virtually all of the police-reported accidents involved a motor vehicle, less than a fifth of the emergency room cases did. Only 10% of the emergency room cases were duplicated on the state accident files. It is estimated that 800 children ages 0-19 are hospitalized annually in North Carolina for bicycle-related injuries, and an additional 13,300 children receive emergency room treatment.

It is well established that alcohol (ethanol) is associated with increased probability of traumatic injury. This relationship has been attributed to alcohol's impairment of judgment and psychomotor performance, leading to increased probability of an injury-producing mishap. Once an accident occurs, it is widely believed that alcohol may protect against injury. However, controlled laboratory studies using animal models indicate that alcohol exacerbates the injurious effects of trauma. In this study, detailed analysis of data from more than 1 million drivers involved in motor vehicle crashes indicates that when the effects of injury-related variables such as safety belt use, vehicle deformation, vehicle speed, driver age, and vehicle weight are taken into account, the drinking driver is more likely to suffer serious injury or death compared with the nondrinking driver. These findings do not support the widespread belief that alcohol is protective against injury, but rather indicate that alcohol increases vulnerability to injury in any given crash.