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    <copyright>Copyright © 2026. National Academy of Sciences. All rights reserved.</copyright>
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    <managingEditor>tris-trb@nas.edu (Bill McLeod)</managingEditor>
    <webMaster>tris-trb@nas.edu (Bill McLeod)</webMaster>
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      <title>Direct Medical Costs of Motorcycle Crashes in Ontario</title>
      <link>https://trid.trb.org/View/1491333</link>
      <description><![CDATA[This article reports on a study undertaken to calculate the direct costs of all publicly-funded medical care provided to individuals after motorcycle crashes and compare those costs to those incurred after automobile crashes. The authors conducted a population-based, matched cohort study of adults in Ontario who presented to the hospital because of a motorcycle (n = 26,831) crash from 2007 through 2013.  Adults who experienced automobile crashes during the same time period (n = 281,826) were matched to the motorcycle cases.  The authors used a difference-in-differences approach to calculate costs attributable to the crashes (within a 2 year period from the time of the crash). Mean costs attributable to motorcycle and automobile crashes were $5825 and $2995, respectively, in Canadian dollars. The study found that the rate of injury was triple for motorcycle crashes compared with automobile crashes (2194 injured annually/100 000 registered motorcycles versus 718 injured annually/100 000 registered automobiles).  In addition, severe injuries were 10 times greater among motorcyclists (125 severe injuries annually/100 000 registered motorcycles versus 12 severe injuries annually/100 000 registered automobiles). The authors determined that, by considering both the attributable cost and higher rate of injury, each registered motorcycle in Ontario costs the public health care system 6 times the amount of each registered automobile.]]></description>
      <pubDate>Wed, 25 Apr 2018 09:22:58 GMT</pubDate>
      <guid>https://trid.trb.org/View/1491333</guid>
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      <title>Pregnancy and the Risk of a Traffic Crash</title>
      <link>https://trid.trb.org/View/1325353</link>
      <description><![CDATA[This article considers the potential impact of pregnancy on the risk of driving errors and traffic crashes.  The population-based, self-matched longitudinal cohort analysis included women who gave birth in Ontario between April 2005 and March 2011 (total n = 507,262 women).  These women experienced 6,922 motor vehicle crashes as drivers during the 3-year baseline interval (177 per month) and 757 motor vehicle crashes as drivers during the second trimester of their pregnancies (252 per month), equivalent to a 42% relative increase.  The crashes were only included if they resulted in a visit to an emergency department.  The authors explored how this increase risk was observed in diverse populations, varied obstetrical cases and across different crash characteristics. . No similar increase was observed in crashes as passengers or pedestrians, cases of intentional injury or inadvertent falls, or self-reported risky behaviors.  The authors note that the absolute risk of a crash during the second trimester was similar to the risks associated with sleep apnea.  They conclude with a brief discussion of the implications for prenatal care and guidelines to focus on safe driving.]]></description>
      <pubDate>Tue, 02 Dec 2014 14:03:21 GMT</pubDate>
      <guid>https://trid.trb.org/View/1325353</guid>
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      <title>Restricted Driver Licensing for Medical Impairments: Does it Work?</title>
      <link>https://trid.trb.org/View/1143896</link>
      <description><![CDATA[Restricted driver licenses, as issued by a number of North American jurisdictions, allow people with medical conditions the right to drive under limited conditions. The authors note that the effectiveness of such licensing has not been empirically proven. Their study evaluates crash rates and traffic violations among 703,758 licensed drivers in Saskatchewan, Canada, between January 1, 1992 and April 19, 1999.  Multivariate Poisson regression is used to determine incident rate ratios (IRRs). Restricted license holders represent 3.3 % (23,185) of the drivers in the study. Results show a lower adjusted risk of involvement in crashes for restricted drivers than unrestricted licensed drivers, along with fewer traffic violations. The authors conclude that restricted licensing programs show significant decreases in crash rates and traffic violations.]]></description>
      <pubDate>Tue, 24 Jul 2012 09:11:24 GMT</pubDate>
      <guid>https://trid.trb.org/View/1143896</guid>
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      <title>Five things to know about child automobile restraints</title>
      <link>https://trid.trb.org/View/1125823</link>
      <description><![CDATA[This one-page article presents an overview of five things for physicians and parents to know about child automobile restraints, including: the importance of guidance from physicians; placing young children up to 2-4 years in rear-facing car seats; using booster seats for children 4-9 years of age; using the back seat for children under age 13; and the availability of Canadian clinics to learn procedures for safe installation of car seats.]]></description>
      <pubDate>Fri, 30 Dec 2011 11:13:38 GMT</pubDate>
      <guid>https://trid.trb.org/View/1125823</guid>
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      <title>Widespread Variations Exist in Bike Helmet Laws across Canada</title>
      <link>https://trid.trb.org/View/1115899</link>
      <description><![CDATA[This article briefly reports on the widespread variations that exist in bicycle helmet laws across Canada.  The author reports that between 1994–98, the rate of bicycle-related head injuries declined in all provinces, but the head-injury rate declined far more significantly (by 45%) in provinces that had adopted helmet laws. In provinces and territories without helmet legislation, the rate only dropped by 27%.  The data is more clear for children than for adult cyclists.  The author reviews the differences in legislation across the provinces: in Nova Scotia, Prince Edward Island, New Brunswick and British Columbia all cyclists are required to wear helmets; in Alberta and Ontario there are helmet laws in place, but in both cases the legislation only applies to those under 18; and Saskatchewan, Manitoba, Quebec and Newfoundland and Labrador there is no legislation governing bicycle helmet use.  The author interviews Dr. Charles Tator, who in 1992 founded ThinkFirst, a national nonprofit organization dedicated to the prevention of brain and spinal cord injuries.  Tator says the goal is to have every province follow the lead of Nova Scotia, which made helmets mandatory for all cyclists — regardless of age — as well as for those using rollerblades, scooters and skateboards.  According to ThinkFirst, each severe brain injury costs the health care system more than $400,000 at the time of injury. And that cost is duplicated each year after the injury, due to intensive follow-up treatments and care involved with brain injuries.  The article concludes by noting the irony of costing society millions of dollars rather than putting on a $20 helmet.]]></description>
      <pubDate>Wed, 21 Sep 2011 07:14:45 GMT</pubDate>
      <guid>https://trid.trb.org/View/1115899</guid>
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      <title>Novice Drivers with Attention-Deficit Hyperactivity Disorder</title>
      <link>https://trid.trb.org/View/912860</link>
      <description><![CDATA[In this commentary article, the author comments on a recent editorial in the Canadian Medical Association Journal (CMAJ) that focused on the high rate of injuries and deaths among youthful drivers.  The editorial emphasized the need to address potentially modifiable human factors in what was characterized as an important public health epidemic.  In this article, the author discusses the safety of drivers with attention-deficit hyperactivity disorder (ADHD).  In the 2006 edition of the Canadian Medical Association's driver guide, physicians are advised to consider treating novice drivers with ADHD with long-acting stimulants, on the basis of a recent meta-analysis examining the effects of a variety of medications used to treat ADHD.  Young drivers with ADHD have been shown to demonstrate a normalization of dysfunctional driving behaviors on a driving simulator and during on-the-road driving when they receive treatment with long-acting methylphenidate compared with treatment with other stimulants and nonstimulants.  The author concludes by applauding the CMA's decision to incorporate evidence-based findings in their new handbook, noting that recommendations in previous editions were based on the consensus opinion of an expert panel.]]></description>
      <pubDate>Fri, 19 Feb 2010 10:56:48 GMT</pubDate>
      <guid>https://trid.trb.org/View/912860</guid>
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      <title>Self-Harm and Risk of Motor Vehicle Crashes Among Young Drivers: Findings from the DRIVE Study</title>
      <link>https://trid.trb.org/View/907769</link>
      <description><![CDATA[This article reports on a prospective cohort study undertaken to assess the risk that intentional self-harm poses for motor vehicle crashes among young drivers.  The authors prospectively linked survey data from newly licensed drivers aged 17–24 years  (n = 18,871) to data on licensing attempts and police-reported motor vehicle crashes during the follow-up period of 2 years.  The study focused on the role of recent engagement in self-harm on the risk of a crash, as well as potential confounders, including number of hours of driving per week, psychological symptoms and substance abuse.  Overall, 1,495 drivers had 1 or more crashes during the follow-up period and 871 drivers (4.6%) reported that they had engaged in self-harm in the year before the survey.  Self-harm behaviors included cutting or burning, self-battering, risk-taking, road-related self-harm, poisoning, and self-harm with lethal intent.  These drivers were found to be at significantly increased risk of a motor vehicle crash compared with drivers who reported no self-harm. This increased risk remained significant, even after adjustment for age, sex, average hours of driving per week, previous crash, psychological distress, duration of sleep, risky driving behavior, substance use, remoteness of residence and socio-economic status.  Most of the drivers who reported self-harm and had a subsequent crash were involved in a multiple-vehicle crash (74 of 88 drivers, 84.1%).  The authors include a brief discussion of intervention strategies that might be useful in this population of at-risk drivers.]]></description>
      <pubDate>Mon, 25 Jan 2010 08:07:57 GMT</pubDate>
      <guid>https://trid.trb.org/View/907769</guid>
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      <title>Sharing the Responsibility for Assessing the Risk of the Driver with Dementia</title>
      <link>https://trid.trb.org/View/842492</link>
      <description><![CDATA[When a physician's role in caring for patients collides with the duty of societal protection, a dramatic, controversial dynamic occurs that often strains the doctor–patient relationship. This is perhaps most salient in the case of a patient with mild dementia who the physician thinks may be an unsafe driver. In most Canadian provinces and all territories, physicians have a mandatory duty to report these patients to relevant licensing authorities. In Alberta, Nova Scotia, and Quebec, the duty to report is discretionary. In British Columbia, reporting is mandatory if an unsafe driver continues to drive after being warned of the danger. However, none of the legislation directly addresses dementia. Even wider variation exists among international legislation and recommendations about drivers with dementia. This paper takes a look at this issue in Canada by defining the problem, detailing current guidelines, and offering some solutions to Canadian physicians when involved in decisionmaking about the need for driving cessation of their patients.]]></description>
      <pubDate>Mon, 28 Jan 2008 08:11:22 GMT</pubDate>
      <guid>https://trid.trb.org/View/842492</guid>
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      <title>Driving Retirement: The Role of the Physician</title>
      <link>https://trid.trb.org/View/818477</link>
      <description><![CDATA[In the United States, licensed drivers over the age of 65 number more than 20 million--a figure that will increase substantially over the next few decades. Certain age-associated conditions such as dementia will lessen the expected increase, since, for reasons of safety, the people affected require earlier cessation of driving. For those diagnosed with Alzheimer's disease, the most common cause of dementia in late life, it's not a matter of if cessation from driving will occur, but simply when. That question of "when" can be difficult to determine, because valid and reliable methods to assess fitness to drive are lacking and little is known about individual, family, and health-related factors that motivate driving cessation in patients with dementia. This article discusses findings reported in a paper authored by Hermann et al., in which data from patients referred to sub-specialists in the Canadian Outcomes Study in Dementia was analyzed to determine baseline factors that predicted driving cessation in older adults with Alzheimer's disease or other dementias. The Hermann et al. study had several strengths, including its prospective design and its use of accepted clinical diagnostic criteria and assessment tools to quantify dementia-related impairment. The findings of the Hermann et al. study, that dementia severity and advanced age are associated with driving cessation, confirmed results from other studies.]]></description>
      <pubDate>Fri, 21 Sep 2007 13:53:25 GMT</pubDate>
      <guid>https://trid.trb.org/View/818477</guid>
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    <item>
      <title>Fitness to Drive</title>
      <link>https://trid.trb.org/View/819536</link>
      <description><![CDATA[A popular guide for physicians on determination of medical fitness to drive is published by the Canadian Medical Association. In the updated 7th edition, notable changes from the 6th edition reflect the emergence of evidence-based medical standards, with emphasis on functional assessment of patients for fitness to drive. This article discusses these aspects of the 7th edition of the aforementioned guide, with a focus on physicians' role in ensuring road safety by making the decision to recommend driving restrictions/cessation in those patients deemed to be limited in their ability to drive or unfit to drive altogether. Driving limitations or cessation decisions are usually based on a physician's ability to determine: functional limits imposed by a medical condition or combination of conditions; the associated risk of a catastrophic event or sudden incapacitation; and temporary impairment of fitness to drive caused by use of certain medications, substances, or procedures.]]></description>
      <pubDate>Fri, 21 Sep 2007 13:53:23 GMT</pubDate>
      <guid>https://trid.trb.org/View/819536</guid>
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    <item>
      <title>Predictors of Driving Cessation in Mild-to-Moderate Dementia</title>
      <link>https://trid.trb.org/View/806642</link>
      <description><![CDATA[This article reports on a study undertaken to explore factors that may affect the likelihood of driving cessation in a sample of elderly, community-dwelling patients with dementia.  The authors conducted a 3-year prospective study, the Canadian Outcomes Study in Dementia (COSID), which enrolled 883 patients with mild-to-moderate dementia at 32 centers across Canada.  Assessment tools included the Mini-Mental State Examination (MMSE) for cognition, the Global Deterioration Scale (GDS) for measuring severity, the Functional Autonomy Measurement System (SMAF) for function, and the Neuropsychiatric Inventory (NPI) for behavior.  The authors also explored factors associated with the decision to quit driving after the baseline assessment.  Of 719 subjects who were or had been drivers, 203 (28.2%) were still driving at baseline.  Over an observation period that averaged 23 months, 97 (48.5%) of 200 patients quit driving.  Factors predictive of driving cessation included GDS, MMSE score, and NPI findings.  Among the NPI behaviors, agitation led to a decreased likelihood of driving cessation, whereas apathy and hallucinations led to an increased likelihood.   the authors conclude by encouraging health care providers to consider these factors when counseling patients and their families.  A final section briefly discusses the authors' concerns about the number of patients with dementia at baseline who were still actively driving.]]></description>
      <pubDate>Wed, 25 Apr 2007 13:46:23 GMT</pubDate>
      <guid>https://trid.trb.org/View/806642</guid>
    </item>
    <item>
      <title>ADHD AND DRIVING SAFETY</title>
      <link>https://trid.trb.org/View/741621</link>
      <description><![CDATA[This is a comment in the paper "Assessment and management of attention deficit hyperactivity disorder in adults" published in the journal "Canadian Medical Association Journal" vol. 168(6) Mar 2003.  The article on the management of attention-deficit hyperactive disorder (ADHD) in adults was exemplary but did not mention one important area of functional impairment: problems with driving.  Although Canadian Medical Association recommendations on assessment of fitness to drive now include uncontrolled ADHD as a medical condition reportable to the provincial ministry of transport, the efficacy of medical interventions in reducing driving risk in adults with ADHD is not well established.  Further research is needed to establish the efficacy of stimulants and newer non-simulant medications in reducing collisions in this high risk population.]]></description>
      <pubDate>Sat, 25 Sep 2004 00:00:00 GMT</pubDate>
      <guid>https://trid.trb.org/View/741621</guid>
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    <item>
      <title>"ADHD AND DRIVING SAFETY": REPLY</title>
      <link>https://trid.trb.org/View/741622</link>
      <description><![CDATA[The article responds to the paper "ADHD and driving safety" by Lawrence Jerome published in the journal "Canadian Medical Association Journal" (2003).  One of the highlights of the recent research on ADHD in adults has been the demonstration that this disorder is associated with increased risk for specific areas of impairment.  Some of this impairment was anticipated clinically, such as the impairment in work and educational achievement predicted by long-term prospective follow-up studies.  We agree that assessment of these specific areas of impairment should be part of both the clinical assessment and the outcome evaluation. In addition, it is anticipated that other areas of impairment, such as difficulty with some aspects of parenting and activities of daily living, will be the subject of research evaluation in the future.]]></description>
      <pubDate>Sat, 25 Sep 2004 00:00:00 GMT</pubDate>
      <guid>https://trid.trb.org/View/741622</guid>
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    <item>
      <title>PSYCHOLOGICAL SEQUELAE OF ACCIDENTAL INJURY</title>
      <link>https://trid.trb.org/View/107542</link>
      <description><![CDATA[LITIGATION FOR PERSONAL INJURY FOLLOWING ACCIDENTAL TRAUMA IS AN EXPENSIVE AND CONFUSED PROCESS INVOLVING THREE PROTAGONISTS' PATIENT, DOCTOR AND LAWYER. ALTHOUGH POST- TRAUMATIC CONDITIONS CAN BE ELABORATELY CLASSIFIED, THE INTRINSIC VALIDITY OF SUCH CLASSIFICATIONS IS OFTEN QUESTIONABLE. CURRENT METHODS OF EVALUATING PSYCHOLOGICAL SEQUELAE OF ACCIDENTAL INJURY ARE INACCURATE AND UNSATISFACTORY, PARTLY BECAUSE OF THE PROTAGONISTS' CONCEPTUAL, MOTIVATIONAL AND SEMANTIC DIFFERENCES. IN ADDITION, THERE IS REALLY NO SATISFACTORY METHOD OF /1/ DETERMINING AND QUANTIFYING MINOR BUT SIGNIFICANT DEGREES OF BRAIN DAMAGE, /2/ DISTINGUISHING THESE FROM POST-TRAUMATIC NEUROSIS, AND /3/ DETERMINING THE RELATIONSHIP BETWEEN THE TRAUMA AND SUBSEQUENT DISTURBANCE OF FUNCTION. INCREASINGLY EXPERT ADVISE IS SOLICITED BUT OWING TO THE NATURE OF THE DATA AND CONDITIONS OF EXAMINATION, SUCH ADVICE DOES LITTLE TO CLARIFY THE UNDERLYING PROBLEMS. FURTHERMORE, DOCTORS ARE OFTEN UNABLE TO COMMUNICATE EFFECTIVELY TO THE JUDICIARY JUST HOW THE TRAUMA HAS AFFECTED THE PATIENT. EVEN THOUGH CERTAIN SUGGESTIONS FOR IMPROVEMENT ARE ADVANCED, THE NEED FOR COMPREHENSIVE, LONGITUDINAL RESEARCH IS INESCAPABLE. /CGRA/]]></description>
      <pubDate>Thu, 11 Aug 1994 00:00:00 GMT</pubDate>
      <guid>https://trid.trb.org/View/107542</guid>
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    <item>
      <title>NIGHT MYOPIA MAY PLACE MANY YOUNG DRIVERS AT RISK, MD SAYS</title>
      <link>https://trid.trb.org/View/385344</link>
      <description><![CDATA[Dr. Thomas Fejer, chief of ophthalmology at Toronto's Women's College Hospital, has concluded that there may be a connection between night myopia and traffic fatalities among young Canadians. Dr. Fejer says that about one-third of young people between the ages of 16 and 25 have night blindness, or night myopia. Night myopia occurs in patients who usually don't have any problems with their vision while driving in daylight. However, at night the eye's focusing mechanism relaxes too much and eyesight turns fuzzy; the condition is more common in young people because their eyes are more pliable. In New Zealand new drivers under age 26 cannot drive between 10 p.m. and 5 a.m. Following the program's introduction in 1987, fatalities dropped by 25 percent in the first 2 years.]]></description>
      <pubDate>Fri, 18 Feb 1994 00:00:00 GMT</pubDate>
      <guid>https://trid.trb.org/View/385344</guid>
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