scholarly journals Inclusion of medical fitness to drive in medical postgraduate training curricula

2020 ◽  
Author(s):  
Laith Al Azawi ◽  
Aisling O’Byrne ◽  
Lily Roche ◽  
Desmond O’Neill ◽  
Margaret Ryan
Keyword(s):  
Medical Condition ◽  
Well Being ◽  
List Type ◽  
Medical Conditions ◽  
Specialist Training ◽  
Fitness To Drive ◽  
Safe Driving ◽  
Training Schemes ◽  
The Uk ◽  
Medical Fitness

AbstractBackgroundTransport mobility, and access to driving, is an important factor in social inclusion and well-being. Doctors have an important role to play in supporting safe mobility through applying the knowledge developed in the field of traffic medicine and incorporating state of the art national and international medical fitness to drive (MFTD) guidelines. Little is known about the profile of MFTD in postgraduate curricula for core and higher specialist training.AimsWe profiled the inclusion of MFTD in the curricula of postgraduate core, higher and streamlined medical and surgical specialties in the Republic of Ireland and the UK. Methods: All publicly available syllabi of basic and higher/ streamlined specialist training in postgraduate medical and surgical colleges in both jurisdictions were analysed (N = 122).ResultsIn Ireland, 25% of basic training schemes included MFTD in the curriculum. Two-thirds of curricula of higher specialty and streamlined training schemes also included MFTD. For the UK, 44% of core and 36% of higher training schemes curricula included MFTD. Just under one-quarter of all curricula reviewed included MFTD for more than one medical condition or treatment. Common topics in both Irish and UK curricula included seizures/epilepsy, syncope and visual disturbances.ConclusionThere are notable deficits in MFTD training for specialists in Ireland and the UK. Common conditions which can significantly impair MFTD such as stroke, diabetes and alcohol use disorders are severely underrepresented and curricula should be revisited to include relevant training and guidance for MFTD for trainees.Main MessagesDoctors have an important role in supporting safe driving among patients with a range of medical conditionsBasic and higher specialist training curricula in a range of specialities in the British Isles are deficient in content relating to medical fitness to driveCurricular development for specialist training should include provision of concise and speciality-relevant guidance on medical fitness to driveResearch QuestionsWhat barriers exist currently to the inclusion of medical fitness to drive and how could these be mitigated?What are the specialty-relevant prioritizations of medical conditions related to medical fitness to drive for inclusion in each curriculum?What resources and evidence are available to specialist training programmes to support the guidance for medical fitness to drive in their curricula?

scholarly journals Comorbidity and COVID-19: Investigating the Relationship between Medical and Psychological Well-being

2021 ◽  
pp. 1-22
Author(s):  
Owen Stafford ◽  
Anna Berry ◽  
Laura K. Taylor ◽  
Sinead Wearen ◽  
Cian Prendergast ◽  
...  
Keyword(s):  
Public Health ◽  
Psychological Distress ◽  
Vulnerable Populations ◽  
Illness Perceptions ◽  
Medical Condition ◽  
Well Being ◽  
Control Group ◽  
Medical Conditions ◽  
Significant Difference ◽  
The Relationship

Abstract Objective: The unprecedented occurrence of a global pandemic is accompanied by both physical and psychological burdens that may impair quality of life. Research relating to COVID-19 aims to determine the effects of the pandemic on vulnerable populations who are at high risk of developing negative health or psychosocial outcomes. Having an ongoing medical condition during a pandemic may lead to greater psychological distress. Increased psychological distress may be due to preventative public health measures (e.g. lockdown), having an ongoing medical condition, or a combination of these factors. Methods: This study analyses data from an online cross-sectional national survey of adults in Ireland and investigates the relationship between comorbidity and psychological distress. Those with a medical condition (n128) were compared to a control group without a medical condition (n128) and matched according to age, gender, annual income, education, and work status during COVID-19. Participants and data were obtained during the first public lockdown in Ireland (27.03.202008.06.2020). Results: Individuals with existing medical conditions reported significantly higher levels of anxiety (p<.01) and felt less gratitude (p.001). Exploratory analysis indicates that anxiety levels were significantly associated with illness perceptions specific to COVID-19. Post-hoc analysis reveal no significant difference between the number of comorbidities and condition type (e.g. respiratory disorders). Conclusion: This research supports individualised supports for people with ongoing medical conditions through the COVID-19 pandemic, and has implications for the consideration of follow-up care specifically for mental health. Findings may also inform future public health policies and post-vaccine support strategies for vulnerable populations.

scholarly journals Determining Fitness to Drive for Drivers with Dementia: A Medical Practitioner Perspective

2019 ◽  
Vol 30 (2) ◽  
pp. 9-17 ◽  
Author(s):  
Joanne Bennett ◽  
Eugene Chekaluk ◽  
Jennifer Batchelor
Keyword(s):  
Medical Practitioner ◽  
Self Report ◽  
Fitness To Drive ◽  
Cognitive Assessments ◽  
Safe Driving ◽  
Medical Practitioners ◽  
People With Dementia ◽  
The Individual ◽  
Almost All ◽  
Medical Fitness

Currently in Australia medical fitness to drive decisions for people with dementia are largely conducted by front line medical practitioners. Little is known about the processes that these practitioners use to make these decisions, and how current guidelines assist in making determinations about driving capacity. A short survey was completed by 42 practitioners. The results of the survey supported previous findings that practitioners do not feel comfortable with making the decision regarding fitness to drive for people with dementia. Practitioners relied largely on self-report or informant information regarding current driving practices. Although practitioners reported that the level of cognitive functioning was the most important factor in determining safe driving, only 25% of practitioners employed cognitive assessments. Whilst the vast majority of practitioners were aware of the fitness to drive guidelines, over half did not find them to be sufficient in enabling determinations of driving capacity. Due to this, almost all practitioners reported that they believe they have missed cases of unsafe driving in this population with over 85% endorsing the need for a more objective tool. Significantly, over three quarters of practitioners reported that they have never received training on how to make fitness to drive decisions. Given that the current driver licensing system for people with dementia depends on medical fitness to drive reviews, the lack of confidence by practitioners regarding making fitness to drive decisions can have a detrimental impact on both the safety of the individual drivers, but also the community as a whole.

scholarly journals The psychosocial impact on frontline health and social care professionals in the UK during the COVID-19 pandemic: a qualitative interview study

2020 ◽  
Author(s):  
Henry Aughterson ◽  
Alison McKinlay ◽  
Daisy Fancourt ◽  
Alexandra Burton
Keyword(s):  
Social Care ◽  
Well Being ◽  
Work Conditions ◽  
List Type ◽  
Qualitative Interview Study ◽  
Health And Social Care ◽  
Wide Range ◽  
Depth Analysis ◽  
Communication Challenges ◽  
The Uk

AbstractObjectivesTo explore the psychosocial well-being of health and social care professionals working during the COVID-19 pandemic.DesignThis was a qualitative study deploying in-depth, individual interviews, which were audio-recorded and transcribed verbatim. Thematic analysis was used for coding.ParticipantsThis study involved 25 participants from a range of frontline professions in health and social care.SettingInterviews were conducted over the phone or video call, depending on participant preference.ResultsFrom the analysis, we identified 5 overarching themes: communication challenges, work-related stressors, support structures, personal growth, and individual resilience. The participants expressed difficulties such as communication challenges and changing work conditions, but also positive factors such as increased team unity at work, and a greater reflection on what matters in life.ConclusionsThis study provides evidence on the support needs of health and social care professionals amid continued and future disruptions caused by the pandemic. It also elucidates some of the successful strategies (such as mindfulness, hobbies, restricting news intake, virtual socialising activities) deployed by health and social care professionals that can support their resilience and well-being and be used to guide future interventions.Strengths and limitations of this studyThis is the first study in the UK to interview both health and social care professionals working in a range of settings on their experiences working through COVID-19.This study used a strong theoretical approach to inform the topic guide, and one-to-one interviews allowed in-depth analysis of the psychosocial experiences of health and social care professionals, complementing the wider availability of quantitative evidence.We interviewed a wide range of professions, which provided breadth of experience but might limit the specificity of findings.Given the fluctuating nature of the pandemic, attitudes of health and social care professionals may change over time. This can be challenging to capture during a single interview, however we did ask questions on how their experience had progressed longitudinally.Our sample may have been biased towards people who had more free time to participate and so were coping better than others. However, our sample still described a number of stressful experiences during the pandemic, and it is also possible that workers who were frustrated or stressed wished to express their views.

scholarly journals Prevalence and changes in boredom, anxiety and well-being among Ghanaians during the COVID-19 pandemic: a population-based study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Godfred O. Boateng ◽  
David Teye Doku ◽  
Nancy Innocentia Ebu Enyan ◽  
Samuel Asiedu Owusu ◽  
Irene Korkoi Aboh ◽  
...  
Keyword(s):  
Mental Health ◽  
Online Survey ◽  
Medical Condition ◽  
Psychometric Evaluation ◽  
Well Being ◽  
Population Based ◽  
Sub Saharan Africa ◽  
Sociocultural Factors ◽  
Medical Conditions ◽  
Psychological Well Being

Abstract Background The outbreak of the COVID-19 pandemic has been associated with several adverse health outcomes. However, few studies in sub-Saharan Africa have examined its deleterious consequences on mental health. Therefore, we investigated the prevalence and changes in boredom, anxiety and psychological well-being before and during the COVID-19 pandemic in Ghana. Methods Data for this study were drawn from an online survey of 811 participants that collected retrospective information on mental health measures including symptoms of generalized anxiety disorder, boredom, and well-being. Additional data were collected on COVID-19 related measures, biosocial (e.g. age and sex) and sociocultural factors (e.g., education, occupation, marital status). Following descriptive and psychometric evaluation of measures used, multiple linear regression was used to assess the relationships between predictor variables and boredom, anxiety and psychological well-being scores during the pandemic. Second, we assessed the effect of anxiety on psychological well-being. Next, we assessed predictors of the changes in boredom, anxiety, and well-being. Results Before the COVID-19 pandemic, 63.5% reported better well-being, 11.6% symptoms of anxiety, and 29.6% symptoms of boredom. Comparing experiences before and during the pandemic, there was an increase in boredom and anxiety symptomatology, and a decrease in well-being mean scores. The adjusted model shows participants with existing medical conditions had higher scores on boredom (ß = 1.76, p < .001) and anxiety (ß = 1.83, p < .01). In a separate model, anxiety scores before the pandemic (ß = -0.25, p < .01) and having prior medical conditions (ß = -1.53, p < .001) were associated with decreased psychological well-being scores during the pandemic. In the change model, having a prior medical condition was associated with an increasing change in boredom, anxiety, and well-being. Older age was associated with decreasing changes in boredom and well-being scores. Conclusions This study is the first in Ghana to provide evidence of the changes in boredom, anxiety and psychological well-being during the COVID-19 pandemic. The findings underscore the need for the inclusion of mental health interventions as part of the current pandemic control protocol and public health preparedness towards infectious disease outbreaks.

scholarly journals Sleep and the Fitness to Drive: A Swiss Perspective

2021 ◽  
Author(s):  
Stefan Lakämper ◽  
Kristina Keller
Keyword(s):  
Traffic Safety ◽  
Legal Medicine ◽  
Behavioral Patterns ◽  
Medical Conditions ◽  
Fitness To Drive ◽  
Medical Assessment ◽  
Safe Driving ◽  
Traffic Medicine ◽  
Swiss Law ◽  
Tiered System

Medical conditions and behavioral patterns affecting sleep are a largely underestimated threat to traffic safety. Unsupervised or even illegal self-treatment of sleep issues by, for example, anti-histamines, cannabis products, or stimulants, questions safe driving and the fitness to drive as well as low compliance/adherence to treatments (CPAP, medication, etc.) of medical conditions, such as OSAS, or narcolepsy. In such cases, Swiss law calls for a medical assessment of the fitness to drive by experts in traffic medicine. With increasing complexity, this medical assessment is escalated in a four-tiered system of qualified experts, ranging from a qualified practitioner to experts in traffic medicine, at, for example, an Institute for Legal Medicine. The following overview provides insight in the Swiss framework of traffic medicine assessments that – with all caveats and potential drawbacks – helps mitigating the risk of sleep-related accidents. For this, we first introduce Swiss traffic medicine and then argue for consistent terms and measurements to assess sleepy driving. A concise summary of those sleep related conditions most relevant in traffic medicine is followed by an overview over potential issues of sleep-medication.

scholarly journals Comorbidity and COVID-19: Investigating the Relationship between Medical and Psychological Well-being

2021 ◽  
pp. 1-23
Author(s):  
Owen Stafford ◽  
Anna Berry ◽  
Laura K. Taylor ◽  
Sinead Wearen ◽  
Cian Prendergast ◽  
...  
Keyword(s):  
Public Health ◽  
Psychological Distress ◽  
Vulnerable Populations ◽  
Illness Perceptions ◽  
Medical Condition ◽  
Well Being ◽  
Control Group ◽  
Medical Conditions ◽  
Significant Difference ◽  
The Relationship

Abstract Objective: The unprecedented occurrence of a global pandemic is accompanied by both physical and psychological burdens that may impair quality of life. Research relating to COVID-19 aims to determine the effects of the pandemic on vulnerable populations who are at high risk of developing negative health or psychosocial outcomes. Having an ongoing medical condition during a pandemic may lead to greater psychological distress. Increased psychological distress may be due to preventative public health measures (e.g. lockdown), having an ongoing medical condition, or a combination of these factors. Methods: This study analyses data from an online cross-sectional national survey of adults in Ireland and investigates the relationship between comorbidity and psychological distress. Those with a medical condition (n=128) were compared to a control group without a medical condition (n=128) and matched according to age, gender, annual income, education, and work status during COVID-19. Participants and data were obtained during the first public lockdown in Ireland (27.03.2020–08.06.2020). Results: Individuals with existing medical conditions reported significantly higher levels of anxiety (p<.01) and felt less gratitude (p≤.001). Exploratory analysis indicates that anxiety levels were significantly associated with illness perceptions specific to COVID-19. Post-hoc analysis reveal no significant difference between the number of comorbidities and condition type (e.g. respiratory disorders). Conclusion: This research supports individualised supports for people with ongoing medical conditions through the COVID-19 pandemic, and has implications for the consideration of follow-up care specifically for mental health. Findings may also inform future public health policies and post-vaccine support strategies for vulnerable populations.

scholarly journals The Impact of Advanced Age on Driving Safety in Adults with Medical Conditions

Gerontology ◽  
2018 ◽  
Vol 64 (3) ◽  
pp. 291-299 ◽  
Author(s):  
Sanghee Moon ◽  
Maud Ranchet ◽  
Abiodun Emmanuel Akinwuntan ◽  
Mark Tant ◽  
David Brian Carr ◽  
...  
Keyword(s):  
Motor Vehicle ◽  
Oldest Old ◽  
Advanced Age ◽  
Driving Safety ◽  
Medical Conditions ◽  
Fitness To Drive ◽  
Middle Aged ◽  
Safe Driving ◽  
History Of ◽  
The Impact

Background: Adults aged 85 and older, often referred to as the oldest-old, are the fastest-growing segment of the population. The rapidly increasing number of older adults with chronic and multiple medical conditions poses challenges regarding their driving safety. Objective: To investigate the effect of advanced age on driving safety in drivers with medical conditions. Methods: We categorized 3,425 drivers with preexisting medical conditions into four age groups: middle-aged (55–64 years, n = 1,386), young-old (65–74 years, n = 1,013), old-old (75–84 years, n = 803), or oldest-old (85 years and older, n = 223). All underwent a formal driving evaluation. The outcome measures included fitness to drive recommendation by the referring physician, comprehensive fitness to drive decision from an official driving evaluation center, history of motor vehicle crashes (MVCs), and history of traffic violations. Results: The oldest-old reported more cardiopulmonary and visual conditions, but less neurological conditions than the old-old. Compared to the middle-aged, the oldest-old were more likely to be considered unfit to drive by the referring physicians (odds ratio [OR] = 4.47, 95% confidence interval [CI] 2.20–9.10) and by the official driving evaluation center (OR = 2.74, 95% CI 1.87–4.03). The oldest-old reported more MVCs (OR = 2.79, 95% CI 1.88–4.12) compared to the middle-aged. Conclusion: Advanced age adversely affected driving safety outcomes. The oldest-old are a unique age group with medical conditions known to interfere with safe driving. Driving safety strategies should particularly target the oldest-old since they are the fastest-growing group and their increased frailty is associated with severe or fatal injuries due to MVCs.

scholarly journals Medical comorbidities of patients presenting to an adult neurodevelopmental new case clinic in Singapore

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S295-S295
Author(s):  
Ho Teck Tan ◽  
James Patrick Moon ◽  
Giles Ming Yee Tan
Keyword(s):  
Neurodevelopmental Disorders ◽  
Medical Condition ◽  
Neurodevelopmental Disorder ◽  
Well Being ◽  
Medical Conditions ◽  
Medical Comorbidity ◽  
Medical Comorbidities ◽  
Respiratory Problems ◽  
Gastrointestinal Conditions

AimsTo describe the occurrence of medical comorbity in patients with neurodevelopmental disorders presenting to the Adult Neurodevelopmental Service (ANDS) multi-disciplinary new case clinic at the Institute of Mental Health (IMH) in Singapore. We hypothesize that patients with neurodevelopmental disorders have higher rates of medical comorbidity compared to those without a diagnosis of neurodevelopmental disorder.BackgroundMedical comorbidities are common in patients with neurodevelopmental disorders. They may have difficulties managing their medical conditions which could in turn affect their well being, quality of life and life expectancy.MethodA retrospective cohort study was conducted amongst patients who presented to the clinic from January 2015 to December 2016. The electronic case records of the assessments were de-identified and the medical conditions of patients were collected and analysed.Result319 patients attended the ANDS new case clinic in the 2-year study period. 87.1% (278/319) were diagnosed with a neurodevelopmental disorder while 12.9% (41/319) did not receive any diagnosis of a neurodevelopmental disorder.58.3% (162/278) of patients with a neurodevelopmental disorder had at least 1 medical comorbidity while only 31.7% (13/41) of patients with no neurodevelopmental disorder had at least 1 medical condition.Patients with neurodevelopmental disorders had higher rates of epilepsy (12.2% vs 4.9%), cerebral palsy (3.2% vs 0%) but lower rates of having other neurological conditions (1.4% vs 7.3%) compared to those with no neurodevelopmental disorders.Patients with neurodevelopmental disorders had higher rates of diabetes (6.1% vs 2.4%), hypertension (6.1% vs 2.4%), hyperlipidaemia (7.1% vs 2.4%) and cardiovascular conditions (2.9% vs 0%) than those without a neurodevelopmental disorder.In terms of other medical comorbidities, patients with neurodevelopmental disorders had higher rates of thyroid abnormalities (4.7% vs 2.4%), respiratory problems (7.6% vs 2.4%), musculoskeletal conditions (5.8% vs 0%), eye issues (5% vs 2.4%) and hearing problems (2.9% vs 0%) but similar rates of dermatological conditions (10.1% vs 9.8%) and gastrointestinal conditions (4.7% vs 4.9%) compared to those with no neurodevelopmental disorders.ConclusionPatients with neurodevelopmental disorders have significantly highly rates of medical comorbidity than those without any neurodevelopmental disorders. This study highlights the need to raise awareness of the common medical comorbidities in patients with neurodevelopmental disorders and to ensure adequate screening and referral for follow-up medical care for them.

scholarly journals Driving and diabetes: are the changes in the European Union licensing regulations fit for purpose?

2018 ◽  
Vol 18 (1) ◽  
pp. 25-31 ◽  
Author(s):  
Alex J Graveling ◽  
Brian M Frier
Keyword(s):  
European Union ◽  
Motor Vehicle ◽  
Driving Performance ◽  
The European Union ◽  
Fitness To Drive ◽  
Everyday Activity ◽  
Vehicle Accidents ◽  
Fit For Purpose ◽  
The Uk ◽  
Medical Fitness

Driving is an important everyday activity for many people with diabetes, which is designated a prospective disability as it may impair driving performance as it progresses in severity. In effect, the principal threat to driving performance is hypoglycaemia associated with insulin therapy. Regular assessment of medical fitness to drive is undertaken to identify drivers with diabetes who are at greatest risk of experiencing motor vehicle accidents. Many countries do not restrict the licensing of drivers with insulin-treated diabetes and fail to review and/or restrict the driving of large goods vehicles or those carrying passengers. The European Union has formulated regulations for driving licensing for diabetes through successive directives, which have been implemented by individual countries including the UK. In response to submissions to relax licensing restrictions, some of these have been amended recently and were implemented in the UK in January 2018. Their rationale and potential value are discussed.

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