Road Traffic: Determination of Fitness to Drive – General

C.H. Wecht , S.A. Koehler , in Encyclopedia of Forensic and Legal Medicine (2nd Edition), 2016

Mortality

The 3 leading causes of natural death among persons aged 65 and over 65 are – eye affliction, cancer, and chronic lower respiratory disease (Older Persons Health). Among unintentional injuries resulting in death, the leading causes are falls followed by MVAs. The CDC reports that over 21   700 people age 65 and older died of fall-related injuries in 2010. In 2008, information from the CDC reported that more than than 5500 older adults were killed and more than 183   000 were injured in motor vehicle crashes (Raedt and Krisoffersen, 2001). The Insurance Institute for Highway Prophylactic estimates that, by the year 2030, 25% of all fatal traffic crashes will involve drivers 65 and older (Older Commuter).

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Cardiac Neurotransmission Imaging

Albert Flotats , Ignasi Carrió , in Clinical Nuclear Cardiology (Fourth Edition), 2010

123I-MIBG Imaging in Arrhythmogenesis

Cardiovascular illness is the single most common cause of natural death in developed countries. SCD accounts for 50% of all cardiovascular deaths. The most common primary electric event at the time of SCD is ventricular tachycardia (VT), which degenerates outset to ventricular fibrillation (VF) and subsequently to asystole. Bradyarrhythmia or electromechanical dissociation are also ofttimes documented, mainly in patients with avant-garde heart disease. 48

SCD is usually attributed to structural center disease, principally in the setting of acute or chronic MI (fourscore%). The cardiomyopathies account for another 10% to 15% of all SCDs. The remaining five% to 10% of SCDs occur in other cardiac disorders, such as valvular or congenital heart diseases, acquired infiltrative diseases, and ion channelopathies. 48 Despite all these epidemiologic information, most SCDs occur amid subjects with no previous cardiovascular history, with an apparent need for strategies to allow screening for markers of increased take chances of death from arrhythmia amidst those with depression- and intermediate-risk profiles 48 ,49 and better therapy and outcome for these individuals.

Current evidence underscores the importance of the autonomic influences in triggering and sustaining arrhythmias in patients with susceptible substrate, 50 and provides of import mechanistic insights into the ionic and cellular mechanisms involved. 1

Heterogeneity of sympathetic innervation in response to injury is highly arrhythmogenic. Sequential changes consisting of nervus degeneration followed past neurilemma cell proliferation and axonal regeneration have been described after episodes of MI, rapid pacing, radiofrequency ablation, hypercholesterolemia, and stem-jail cell transplantation. 51 Co-ordinate to this "nerve-sprouting" hypothesis, it is possible that the resulting sympathetic hyperinnervation might increment the propensity for cardiac arrhythmia. The coexistence of denervated and hyperinnervated areas in the diseased myocardium could upshot in increased electrophysiologic heterogeneity during sympathetic activation, leading to ventricular arrhythmia and SCD. 51 Ventricular tachyarrhythmias can be provoked in these patients with heterogeneous remodeling of sympathetic innervation, attributable to nerve growth and degeneration past physical or mental stress or by catecholamine application. On the other hand, adrenergic denervation of viable myocardium may too result in denervation supersensitivity, with exaggerated response of myocardium to sympathetic stimulation and increased vulnerability to ventricular arrhythmias. 52 ,53 Therefore, when assessing the arrhythmogenic potential, variables such as the presence of denervated but feasible myocardium, the severity of denervation, the underlying level of sympathetic tone, and the subsequent influences on local ventricular repolarization should be taken into account.

While prevention of arrhythmic deaths is generally ineffective with pharmacologic treatment, 54 implantable cardioverter defibrillators (ICDs) reduce the bloodshed charge per unit in subgroups of patients thought to be at run a risk. 55 ,56 However, identification of patients who virtually do good from these devices remains difficult, and implantation of the device in patients who volition non benefit leads to unnecessary morbidity, with increased medical costs. 57 ,58 Current available methods for precise identification of individuals at risk for SCD, such as conventional coronary take chances factors, functional damage, caste of LV dysfunction, and cardiovascular testing analyzing electrocardiographic (ECG) variables and Holter monitoring (frequency of premature ventricular depolarizations, nonsustained and sustained VT) have low accurateness. Additionally, heart rate variability (HRV) and baroreflex sensitivity however take an unknown predictive value. On the other manus, electrophysiologic testing has relatively low sensitivity and positive predictive value. 48 Arora et al. 59 evaluated the utilise of 123I-MIBG cardiac imaging (as means of local myocardial sympathetic innervation) and spectral analysis of HRV (as means of central autonomic tone) in patients with ICDs. They studied 17 patients who had ICDs for various indications. The combined use of 123I-MIBG scintigraphy and HRV analysis correlated with the occurrence of an appropriate ICD discharge. Patients with ICD discharges had lower early on HMR, more extensive 123I-MIBG defects, and more 123I-MIBG/99mTc-sestamibi (technetium-99m-labeled sestamibi) mismatch segments (denervation in areas of myocardial viability) compared to patients without previous ICD discharge. In addition, the ICD discharge group had reduced values for HRV, suggesting abnormally increased sympathetic tone, when compared with patients without previous ICD discharge. Therefore, the combined noninvasive evaluation of local cardiac autonomic innervation and systemic autonomic function by means of 123I-MIBG and HRV immune identification of patients at risk for potentially fatal arrhythmias and SCD, who were most likely to benefit from an ICD.

Schäfers et al. 60 reported the use of 123I-MIBG SPECT in 25 patients with IVF, demonstrating presynaptic innervation defects in these patients. The same grouping of investigators subsequently reported the long-term follow-up in 20 of these patients, 61 13 of whom showed aberrant 123I-MIBG uptake. During a follow-up catamenia of seven.2 ± 1.5 years, 18 episodes of VF/fast polymorphic ventricular tachycardias occurred in 4 IVF patients with abnormal 123I-MIBG uptake, while merely ii episodes of monomorphic ventricular tachycardia (and no VF) occurred in a single IVF patient with normal 123I-MIBG uptake. Therefore, dumb 123I-MIBG uptake may indicate a higher risk of future recurrent episodes of life-threatening ventricular tachyarrhythmias in patients with IVF.

Simões et al. 62 subsequently evaluated 67 consecutive patients inside xiv days after acute MI by means of resting myocardial perfusion imaging, 123I-MIBG cardiac imaging, and electrophysiologic parameters. They reported a significant correlation between the extent of sympathetically denervated but feasible myocardium and prolonged repolarization, divers by QTc interval in resting ECG, and indexes of delayed depolarization from signal-averaged ECG. Nonetheless, a pregnant relation between the presence and frequency of ventricular arrhythmias and the extent of denervated simply viable myocardium could not be demonstrated subsequently 4.3 ± 1 years of follow-up. This could be related to the depression incidence of ventricular arrhythmias in the written report population, and possibly the fact that patients with severely depressed LV function were not included. In a stage 2, open-characterization, multicenter study that enrolled l patients with LV dysfunction and previous myocardial infarction, Bax et al. 63 found that late 123I-MIBG SPECT defect score was the merely variable which showed a pregnant departure between patients with and without positive electrophysiological studies. Further studies should demonstrate clinically relevant gamble stratification of 123I-MIBG imaging, such as high negative predictive value for life-threatening ventricular arrhythmias, peculiarly in patients with ischemic heart illness and depressed LVEF.

Increase of the electrical heterogeneities of ventricular repolarization contributes to the electrocardiographic phenotype and arrhythmogenicity of ion channelopathies such as the Brugada and long-QT syndromes, despite structurally normal hearts. The ANS plays a prominent role in unmasking these syndromes and precipitating life-threatening ventricular tachyarrhythmias. Both sympathetic and parasympathetic influences on ion channel activity have been found to accentuate electrical heterogeneities, thus contributing to arrhythmogenesis in the long-QT and Brugada syndromes. one

123I-MIBG studies have demonstrated reduced and heterogeneous uptake associated with increased regional WR in patients with long-QT syndrome. 64 ,65 Likewise, Wichter et al. 66 reported reduced 123I-MIBG uptake in the inferior and septal LV walls in 47% of patients with Brugada syndrome compared with command subjects, which pointed to presynaptic sympathetic dysfunction of the heart in a large proportion of patients with Brugada syndrome. The pathophysiologic implication of these findings requires further investigation.

Ventricular loss of myocytes and fatty or fibrofatty tissue replacement, resulting in regional or global abnormalities, are the main structural abnormality in arrhythmogenic right ventricular cardiomyopathy (ARVC). 67 It has been shown with 123I-MIBG SPECT and elevenC-hydroxyephedrine PET that although the LV is non involved in the disease, there is prove of global and regional denervation in presynaptic catecholamine reuptake and storage of the LV, too equally a reduction in the postsynaptic β-adrenoceptor density assessed past 11C-CGP PET. 68–70 Correlation of observed regional abnormalities of 123I-MIBG uptake in the basal posteroseptal regions of the LV with the site of origin of VT (equally demonstrated by electrophysiologic testing) has been reported. 68 ,69 These findings advise a reduced activity of the NE transporter (uptake-1), with subsequent β-adrenoceptor down-regulation, and take potential impact on diagnostic evaluation and therapeutic management of patients with ARVC.

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Mental health and common psychiatric disorders associated with aging

Virginia C. Stoffel PhD, OT, BCMH, FAOTA , ... George T. Grossberg MD , in Occupational Therapy with Aging Adults, 2016

Run a risk

Clients with schizophrenia have a higher mortality compared with the general population. The nigh common natural causes of decease are respiratory and cardiovascular diseases. Accidental falls followed by suicide are the most common unnatural causes of death. 68 Suicide take a chance factors are depression, commanding hallucinations, and somatic delusions. Negative long-term prognosis is seen in clients with poorer premorbid psychosocial and overall functioning, prominent negative symptoms, gradual symptom onset, and early on disease severity. The amount of time experiencing psychotic symptoms in the starting time 2 years of the illness is the strongest predictor of disability. 37

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Forensic Medicine/Clinical

S. Heide , in Encyclopedia of Forensic Sciences (2nd Edition), 2013

Mode and Cause of Death

In the North American region, the proportion of natural deaths in police custody is significantly higher than in Europe. More than half of the 229 deaths in Florida (USA) had natural causes. In stark contrast, natural causes of expiry in Europe are only twenty%. In European countries, causes of unnatural death are predominately intoxication and trauma. The German study found that alcoholic intoxication and cerebrocranial trauma were prevalent ( Effigy 2 ).

Figure 2. Causes of death for the threescore deaths in German language police custody.

Other European countries show a similar blueprint. In Finland and Denmark, the almost frequent cause of death was acute alcoholic intoxication; in the Netherlands, the about mutual cause of death was intoxication by a variety of substances. In England and Wales (Corking Uk), intoxication induced past booze or medical and illegal drugs was responsible for a third of all deaths. The number of deaths by trauma was smaller: the proportion of deaths caused past craniocerebral injuries in Europe, for case, was largely betwixt x% and 20%.

In North American studies, the distribution of the cause of death differs significantly. In Florida (USA), for example, heart and lung diseases, secondary diseases of alcohol consumption, and suicides were prevalent. The Florida data therefore rather corresponds to the causes of death observed in persons in the custody of European prisons, which are predominated by cardiovascular diseases and suicides by hanging.

An international comparison reveals that, compared to European countries, death of excited persons during police restraining and send measures can be found more oft in North America. This may exist due to a greater frequency of drug intoxication (such as excited deliria influenced past cocaine) and different restraining techniques.

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Introduction

Jarvis Hayman MB,ChB, FRCS(Ed), FRACS, MA(Hons) Archaeology, PhD , in Interpretation of Time Since Death in Australian Conditions, 2021

one Introduction

Information technology is well recognised amid forensic anthropologists and archaeologists that estimations of the fourth dimension since expiry (TSD) in human being bodies found decomposed are dependent on multiple factors which include the context in which the trunk is discovered, the environment, climate and geographical factors. This thesis attempts to develop a method of estimating the TSD in the Australian conditions by kickoff examining the statistics concerning decomposed human bodies and then formulating a mathematical model earlier testing the method on actual decomposed human bodies.

The finding of a decomposed human body raises the possibility of four causes of death: natural, accidental, homicide or suicide, and with each crusade it is important to determine the TSD. In the case of homicide the TSD may assist in narrowing downwards the list of possible perpetrators, and in the example of the other three it may aid in determining the causes of and reasons for the decease and in comforting the shut relatives of the deceased.

The starting time known written documentation of forensic methods and estimation of the TSD is in a 13th century Chinese Sung Dynasty textbook entitled Hsi Yuan Lu, the Washing Abroad of Wrongs past Sung Tz'u (Gwei-Djen and Needham, 1988), while the modern era of forensic investigation into the estimation of TSD tin can be attributed to Dr John Davey in Ceylon (Sri Lanka) at the kickoff of the 19th century when he recorded the temperature of recently deceased soldiers (Davy, 1839).

Although desultory studies were conducted in the 19th century, there was a notable lack of any enquiry until the 1950s perchance because of the intervention of two world wars and the Groovy Depression at the start of the 20th century.

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The Brugada Syndrome

Pedro Brugada , ... Josep Brugada , in Cardiac Electrophysiology (Fourth Edition), 2004

SUMMARY

In 1992, a syndrome was described consisting of syncopal episodes and/or (resuscitated) sudden death in patients with a structurally normal heart and a characteristic electrocardiogram (ECG) displaying a pattern resembling a correct package branch block (BBB) with ST segment elevation in leads V1 to V3. The disease is genetically determined with an autosomal dominant pattern of manual in 50% of the familial cases. Several dissimilar mutations take been identified affecting the construction, function, and trafficking of the sodium aqueduct. The syndrome is ubiquitous. Its incidence and prevalence are difficult to gauge, but this illness may cause iv to ten sudden deaths per 10,000 inhabitants per year, representing the most frequent crusade of natural death in males younger than 50 years in Due south Asia. The disease has been linked to the sudden baby death syndrome (SIDS) and to the sudden unexpected death syndrome (SUDS) by showing that the ECG and mutations are the aforementioned as in Brugada syndrome. The diagnosis is easily fabricated by means of the ECG when it is typical. However, patients exist with concealed and intermittent electrocardiographic forms that make the diagnosis difficult. The ECG tin can be modulated by changes in autonomic residual, trunk temperature, glucose level, and the administration of antiarrhythmic, neuroleptic, and antimalaria drugs. β-adrenergic stimulation normalizes the ECG. Loss of the activity potential dome in the right ventricular epicardium but not in the endocardium underlies the ST segment elevation. Electrical heterogeneity within the right ventricular epicardium leads to the development of closely coupled extrasystoles via phase 2 reentry that precipitate ventricular fibrillation (VF). Antiarrhythmic drugs do not prevent sudden death in symptomatic or asymptomatic individuals. Implantation of an automatic cardioverter-defibrillator is the only currently proven effective therapy. Patients with frequent electric storms may even need cardiac transplantation equally a last resort.

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The Genetics of Cardiac Electrophysiology in Humans

Reed E. Pyeritz , in Emery and Rimoin'due south Principles and Exercise of Medical Genetics, 2013

51.3.iii Sudden Unexpected Nocturnal Death Syndrome

51.3.iii.1 Clinical Features

SUNDS is a disorder that occurs in Southeast Asia, particularly Thailand, Cambodia, and the Philippines, as well every bit in Japan. The clinical features of this disorder are highlighted by the flamboyant names given this disease in the various Asian countries: lai-tai (died during slumber) in Thailand, pokkuri (sudden unexpected death at dark) in Japan, and bangungut (moaning and dying during sleep) in the Philippines. SUNDS is the most mutual cause of "natural" death in these countries, typically occurring during sleep in males (141,142). The clinical features include an aberrant surface ECG with ST segment superlative in the right precordial leads (51–Viii), with or without RBBB. VF leads to the clinical symptoms of syncope, sudden death, and resuscitated sudden death. SUNDS is an allelic grade of Brugada syndrome as the gene responsible for SUNDS is the same as the Brugada syndrome cistron (Table 51-2).

51.iii.three.2 Genetics and Management

SUNDS has non been considered an inherited disorder, but we have identified some families in which SUNDS is inherited equally an autosomal ascendant trait with mutations in SCN5A, the cardiac sodium-channel gene (170). The genetic findings have been confirmed by others (142,171). It is non currently clear why SUNDS afflicts men about exclusively, just information technology is certain that this is not transmitted in an X-linked manner, as male-to-male person transmission occurs.

The management of SUNDS depends on implantation of an ICD in order to rapidly treat whatsoever episodes of VF. No medical therapy has proven effective for this disorder, simply if quinidine therapy "pans out" for Brugada syndrome, information technology is probable that it would be used for SUNDS too. Another important step necessary for optimal therapy of SUNDS is the screening of all family members past surface ECG testing. It is possible that provocation tests, similar to those described in Brugada syndrome, may exist useful, but this has not been proven thus far.

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Mortality Rate and Long-Term Outcomes After Bariatric Surgery

S.1000.B. Kelles , in Metabolism and Pathophysiology of Bariatric Surgery, 2017

Mid- and Long-Term Mortality Due to Specific Causes

Mortality Due to Natural Causes

Morino et al. [16] reported that 29.4% of deaths following bariatric surgery were due to complications of this process. Bruschi Kelles et al. [17] found that 84% of deaths in a cohort of 4344 subjects were due to natural causes, and that 16% were caused past external causes unrelated to diseases.

Descriptions of specific causes of long-term deaths in operated subjects were sparse. Data on specific causes of mortality following bariatric surgery showed that cardiovascular diseases and malignancy were the about frequent causes of death. Sjöström [iii] institute that malignancy and fatal acute myocardial infarction were the most common causes of death both in the command grouping and the surgery group, only the study lacked statistical ability, and the authors were unable to estimate gamble reduction co-ordinate to specific causes of death. Pontiroli'southward meta-analysis [7] found a lower run a risk of cardiovascular mortality later bariatric surgery when compared to nonsurgery individuals. However, the authors pointed out that the studies in this meta-analysis had not been randomized, that they were heterogeneous in size, time, and loss of follow-up, and that determination of death was based on death certificates which, in many instances, may accept distorted the expiry report.

Adams et al. [18] showed that patients undergoing bariatric surgery had a lower gamble of death by specific causes such as stroke and cancer when compared to severely obese nonoperated controls.

Thus, after bariatric surgery, the main causes of natural death, in general, remain the same as those observed in nonoperated severely obese patients. While a decrease in overall mortality is observed in about studies, the magnitude of the effect on mortality due to cardiovascular events and cancer in individuals who lose weight after bariatric surgery is provided by observational studies (i.due east., heterogeneous and lacking in statistical power). These outcomes, therefore, remain controversial.

Bloodshed by External or Violent Causes

Although global mortality and bloodshed by natural causes take decreased compared to nonoperated obese individuals, at that place is systematically a high rate of deaths past external causes unrelated to diseases.

Davidson et al.'s [19] accomplice consisted of 7925 gastric featherbed surgery patients compared with a group-matched control group consisting of 7925 severely obese nonoperated individuals identified past driver license records. The follow-up was 7.two years. The authors sought the age groups that would benefit near from bariatric surgery in terms of survival. Except for patients anile beneath 35 years, survival increased in the other historic period groups compared to nonoperated individuals. No do good was seen in patients below 35 years of age; the authors suggested that a high prevalence of deaths by external causes in this group accounted for this finding. The HR was 2.35 (95% CI, one.27–5.07); amidst women the HR was 3.08 (95% CI, 1.four–half dozen.7).

Omalu et al. [20] assessed the causes of expiry in 16,683 bariatric surgery patients from 1995 to 2004 with a 5-year follow-upwards. Natural causes accounted for 90% of deaths; ten% were traumatic deaths. Of 45 violent deaths, sixteen were suicides, 10 were due to automobile accidents, 14 resulted from drug overdose, three were homicides, and two deaths were due to falls. The suicide rate was much college compared to similarly aged groups in the general population.

Tindle et al. [21] reanalyzed this population and institute a 6.6/10,000 suicide rate amongst bariatric surgery individuals. For comparing, the sex- and age-adapted suicide rate in the Usa was ii.4/10,000 in males and 0.7/ten,000 in females. About 30% of suicides occurred inside 2 years of surgery and 70% occurred inside three years post-obit surgery.

The percentage of suicides in a Brazilian cohort [17] of 4344 bariatric surgery patients with a 10-year follow-upward was 10%.

Adams et al. [eight] plant that the risk of suicide in a bariatric surgery group after adjusting for historic period, BMI, and sex was double that of controls.

The causes of such a high charge per unit of suicide required farther investigation. Sansone et al. [22] establish that 10% of bariatric surgery candidates reported previous suicide attempts, the most significant risk gene for fatal suicides. An association betwixt obesity and fatal suicide or suicide attempts is controversial, but information technology appears that the chance is higher in bariatric surgery patients. Henegham et al. [23] plant a higher suicide take chances among obese individuals, and that this chance remained afterwards bariatric surgery. Other papers have likewise reported a loftier suicide charge per unit afterward bariatric surgery [24].

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ROAD TRAFFIC, Decision OF FITNESS TO DRIVE | Full general

C.H. Wecht , S.A. Koehler , in Encyclopedia of Forensic and Legal Medicine, 2005

Americans: Historic period 65 and Over

Population

In 1980, the US population of individuals aged 65 and over represented 26.five million (11.3%) of the total United states population. 10 years later this population increased to 30.nine million, 12.v% of the full population. Based on projections, by the yr 2025 more than than 18% of the United states population will exist 65 and older, and past 2040 the elderly will correspond 20% (68 million) of the U.s.a. population. The per centum of individuals anile 85 and older is increasing at a faster rate than ever before.

Mortality

The 2 leading causes of natural death among individuals aged 65 and over are cancer and eye disease. Among unintentional injuries resulting in death, the two leading causes in the 65–74-year-old group are motor vehicle accidents and falls. The Insurance Institute for Highway Safety estimates that, by the year 2030, 25% of all fatal traffic crashes will involve drivers 65 and older.

Number of Licenced Drivers

Currently, older drivers represent just a fraction of the full driving public. However, they correspond the fastest-growing segment of the driving population. In 1980, there were 13.3 million licenced older drivers, representing nine.3% of all drivers in the USA. Past 1991, there were 21.8 million, representing xiii%, with vi.half dozen million (4%) drivers over 85 years quondam. The Federal Highway Administration reported that in 1996 at that place were 15   648   000 licenced drivers anile 65–74 years, and 9   522   000, aged 75 and over. It has been estimated that, by the twelvemonth 2020, more 15% of drivers will be older than 65 years. The National Establish on Aging estimates that, by 2030, in that location volition be an estimated 40 one thousand thousand licenced drivers, with 25% of all drivers aged 65 and over, and nigh 9 million of these aged 85 and over.

Motor Vehicle Crashes

Accidents were the fourth leading cause of death in the United states of america in 1999; motor vehicle accidents accounted for over half of these deaths. Machine crashes in the USA in 1999 claimed the lives of xl   000 individuals and disabled 2.2 million. The pattern of motor vehicle crashes and fatal motor vehicle accidents in the Us is U-shaped. The number of fatal motor vehicle accidents is high among drivers anile xvi–24 years erstwhile; information technology then steadily decreases until the age of 45–55. Later on the age of 55, it starts to increase, with the greatest increase occurring after the age of 60. The accident rates for drivers anile 16–19 is 28 per million miles driven, whereas in adults older than 85 years the rate jumps to 85 accidents per one thousand thousand miles driven.

Contour of Elderly Drivers

Driving is an economical, social, and recreational necessity for most Americans and plays a fundamental office in the lives of adults, particularly older adults, who rely on the individual automobile for 88% of their transportation needs. Individuals with preexisting medical conditions and/or those who develop atmospheric condition that can affect their driving performance will upshot in a conflict betwixt reasonable transportation opportunities, the role of physicians, and social club's need to protect public safety.

Most seniors are as capable of driving safely as their younger counterparts, and when they get enlightened that they have a problem, they typically deed responsibly by limiting or modifying their driving habits. Older drivers in general drive less, drive less at dark, avert heavy traffic times and complicated roadways, and limit their geographic area. Ever-growing traffic volumes, congestion, and novel highway features and vehicle technologies demand greater attending by drivers. They incur accidents in situations that require astute perception, trouble-solving ability, firsthand reactions, and agile determination-making. Nevertheless, older drivers are overrepresented when fatalities or crashes are adjusted for vehicle miles traveled. They commit more driving errors, such every bit failure to yield correct-of-way, incorrect lane changes, and improper turning, particularly left-hand turns, and turning from the wrong lane. When they crash, elderly drivers are more probable to incur injury and death. As a group, people older than 65 years all the same have fewer accidents than any other age group, largely because they bulldoze fewer kilometers. Those older than 75 years are twice as likely as the average driver, per mile driven, to crash their cars, while those older than 85 are two.v times more likely, even without aligning for miles driven. Men are two–4 times more likely to crash than women, even when adjusted for the increased time men spend driving, though this difference begins to disappear later in life.

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Cardiovascular diseases among patients with schizophrenia

Muhammad Chanchal Azad , ... Tanvir Chowdhury Turin , in Asian Journal of Psychiatry, 2016

ii.i Causes of bloodshed in schizophrenia

The significantly lower life expectancy in schizophrenia can be attributed to death from both natural and unnatural causes. Causes of natural deaths in schizophrenia include cardiovascular diseases, respiratory diseases, cancer, unrecognized medical diseases, poor compliance, refusal of treatment for medical diseases, unhealthy life style, substance misuse and antipsychotic drug side effects (Brownish et al., 2000; Bushe et al., 2010; von Hausswolff-Juhlin et al., 2009). Unnatural deaths are mainly caused by suicides and accidents (Brownish, 1997). Natural and unnatural causes business relationship for nearly threescore% and forty% of all deaths in schizophrenia respectively (Ringen et al., 2014).

The contribution of cancer to mortality in schizophrenia ranges from vii to 21% of all causes of deaths (Brown et al., 2000; Capasso et al., 2008; Chong et al., 2009; Dean and Thuras, 2009; Fors et al., 2007; Mortensen and Juel, 1993; Tran et al., 2009). The cancer mortality charge per unit among patients with schizophrenia has been reported higher than the full general population in studies in Australia and Denmark (Dalton et al., 2008; Lawrence et al., 2000). Lung and breast cancer are the two commonest malignancies in schizophrenia (Bushe et al., 2009; Catts et al., 2008; Hippisley-Cox et al., 2007). An 11-year prospective bloodshed study among 3470 patients with schizophrenia revealed that lung cancer contributed 50% of all cancer in males and breast cancer contributed 39% of all cancer in females (Tran et al., 2009). 80% of incident cases of breast cancer arose amid patients with schizophrenia who were over 50 years erstwhile (Bushe et al., 2009). A remarkably large mortality report amidst 17,600 patients with schizophrenia over seven years flow reported mortality rate ratio for CVD 2.07 and 1.72 and malignant neoplasms i.24 and ane.32, for males and females, respectively (Laursen et al., 2007).

The contribution of respiratory diseases and other natural causes to bloodshed in schizophrenia varies beyond the studies. There may be unlike causes of backlog mortality in Asian countries, compared to Western countries with an excess of respiratory causes and infectious disease in-patient with schizophrenia. For example, a study in France reported 18% contribution from respiratory causes, whereas other study among Asian patients reported 66% contribution to mortality (Chong et al., 2009; Tran et al., 2009). Yet, the information from Asian countries is sparse.

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