***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE The purpose of this article was to investigate the role of control beliefs in mediating the relationship between driving cessation and change in depressive symptoms in a population -based sample of older adults . DESIGN AND METHODS We report results from a prospect i ve , community-based cohort study that included two waves of data collected in 1992 and 1994 . Participants consisted of 700 men and women aged 70 and older , including 647 drivers and 53 participants who ceased driving between baseline ( 1992 ) and follow-up ( 1994 ) . Participants took part in interviews that included assessment s of driving status , sociodemographic characteristics , self-rated health , sensory function , depressive symptoms ( through the Center for Epidemiologic Studies -Depression scale ) , and expectancy of control . Using multilevel general linear models , we examined the extent to which driving status , expectancy of control , and relevant covariates explained change in depressive-symptom scores between baseline and follow-up . RESULTS Driving cessation was associated with an increase in depressive symptoms from baseline to follow-up . The higher depressive-symptom scores of ceased drivers relative to those of individuals who remained drivers at both waves was partly explained by a corresponding decrease in the sense of control among ceased drivers , and increased control beliefs among drivers . IMPLICATION S Interventions aim ed at promoting the maintenance of personal agency and associated control beliefs could be protective against the negative psychological concomitants of driving cessation Driving has been regarded as an activity of daily living that is important in maintaining a person 's independence in the community , access to employment , and social activities . Many patients , however , using opioid medications on a regular basis ( Chronic Opioid Analgesic Therapy : COAT ) to ameliorate their intractable pain have been restricted from driving out of concern that skills would be impaired and driving safety compromised by these medications . Yet there are no driving studies which have explored the effects of using opioid analgesics for an extended period of time . This pilot study was design ed to determine the effects of medically prescribed , stable opioid use on the driving abilities of patients with persistent , nonmalignant pain . Sixteen patients with chronic nonmalignant pain on COAT , who met criteria for participation in the study , underwent a comprehensive off-road driving evaluation using measures which have been shown to be sensitive in predicting on-road driving performance . The evaluation consisted of a pre-driver evaluation ( PDE ) , a simulator evaluation ( SDE ) , and behavioral observation during simulator performance .  Patients in the COAT group were compared to a historical control group of 327 cerebrally compromised patients ( CComp ) who had undergone the same evaluation and then passed an on-road , behind-the-wheel evaluation ( BTW Pass ; n = 162 ) or failed ( BTW Fail ; n = 165 ) . Results revealed that COAT patients generally outperformed the CComp patients as a group by equaling or exceeding PDE and SDE scores of the BTW Fail patients as well as the BTW Pass patients on all measures that differentiated the groups . Notably , COAT patients had a relatively poorer performance than CComp patients on specific neuropsychometric tests in the PDE ; however , the differences were not statistically significant and did not imply a systematic pattern of scores that reflected domain-specific deficits . Behaviorally , COAT patients were generally superior to CComp patients , also ; however , COAT patients had greater difficulty in following instructions and as well as a tendency toward impulsivity , like the BTW fail group . While there was general support for the notion that COAT did not significantly impair the perception , cognition , coordination , and behavior measured in off-road tests that have been regarded as requisite for on-road driving , method ological problems may limit the generalizability of results and recommendations are made for research beyond a pilot study & NA ;  Pain intensity is frequently measured on an 11‐point pain intensity numerical rating scale ( PI‐NRS ) , where 0=no pain and 10=worst possible pain . However , it is difficult to interpret the clinical importance of changes from baseline on this scale ( such as a 1‐ or 2‐point change ) . To date , there are no data driven estimates for clinical ly important differences in pain intensity scales used for chronic pain studies . We have estimated a clinical ly important difference on this scale by relating it to global assessment s of change in multiple studies of chronic pain . Data on 2724 subjects from 10 recently completed placebo‐controlled clinical trials of pregabalin in diabetic neuropathy , postherpetic neuralgia , chronic low back pain , fibromyalgia , and osteoarthritis were used . The studies had similar design s and measurement instruments , including the PI‐NRS , collected in a daily diary , and the st and ard seven‐point patient global impression of change ( PGIC ) , collected at the endpoint . The changes in the PI‐NRS from baseline to the endpoint were compared to the PGIC for each subject . Categories of ‘ much improved ’ and ‘ very much improved ’ were used as determinants of a clinical ly important difference and the relationship to the PI‐NRS was explored using graphs , box plots , and sensitivity/specificity analyses . A consistent relationship between the change in PI‐NRS and the PGIC was demonstrated regardless of study , disease type , age , sex , study result , or treatment group . On average , a reduction of approximately two points or a reduction of approximately 30 % in the PI‐NRS represented a clinical ly important difference . The relationship between percent change and the PGIC was also consistent regardless of baseline pain , while higher baseline scores required larger raw changes to represent a clinical ly important difference . The application of these results to future studies may provide a st and ard definition of clinical ly important improvement in clinical trials of chronic pain therapies . Use of a st and ard outcome across chronic pain studies would greatly enhance the comparability , validity , and clinical applicability of these studies Abstract Objective To determine the efficacy of oral morphine in relieving the sensation of breathlessness in patients in whom the underlying aetiology is maximally treated . Design R and omised , double blind , placebo controlled crossover study . Setting Four outpatient clinics at a hospital in South Australia . Participants 48 participants who had not previously been treated with opioids ( mean age 76 , SD 5 ) with predominantly chronic obstructive pulmonary disease ( 42 , 88 % ) were r and omised to four days of 20 mg oral morphine with sustained release followed by four days of identically formulated placebo , or vice versa . Laxatives were provided as needed . Main outcome measures Dyspnoea in the morning and evening as shown on a 100 mm visual analogue scale , quality of sleep , wellbeing , performance on physical exertion , and side effects as measured at the end of the four day treatment period . Results 38 participants completed the study ; three withdrew because of definite and two because of possible side effects of morphine  ( nausea , vomiting , and sedation ) . Participants reported significantly different dyspnoea scores when treated with morphine : an improvement of 6.6 mm ( 95 % confidence interval 1.6 mm to 11.6 mm ) in the morning and of 9.5 mm ( 3.0 mm to 16.1 mm ) in the evening ( P = 0.011 and P = 0.006 , respectively ) . During the period in which they were taking morphine participants also reported better sleep ( P = 0.039 ) . More participants reported distressing constipation while taking morphine ( 9 v 1 , P = 0.021 ) in spite of using laxatives . All other side effects were not significantly worse with morphine , although the study was not powered to address side effects . Conclusions Sustained release , oral morphine at low dosage provides significant symptomatic improvement in refractory dyspnoea in the community setting OBJECTIVES Increasing age , socioeconomic factors , and declining function and health have been linked to driving cessation , but little is known about the consequences of stopping driving . This study was design ed to test the hypothesis that driving cessation leads to a decline in out-of-home activity levels . METHODS In 1989 a survey of driving practice s was administered to surviving noninstitutionalized members of the New Haven Established Population s for Epidemiologic Studies of the Elderly ( EPESE ) cohort . Of 1,316 respondents , 502 were active drivers as of 1988 , 92 had stopped driving between 1982 and 1987 , and 722 never drove or stopped before 1982 . Information on sociodemographic and health-related variables came from in-home EPESE interviews in 1982 , 1985 , and 1988 , and from yearly phone interviews . Activity was measured at all three in-home interviews , and an activity measure was created based on self-reported participation in nine out-of-home activities . A repeated measures r and om-effects model was used to test the effect of driving cessation on activity while controlling for potential confounders . RESULTS Driving cessation was strongly associated with decreased out-of-home activity levels ( coefficient-1.081 , st and ard error 0.264 , p < .001 ) after adjustment for sociodemographic and health-related factors . DISCUSSION The potential consequences of driving limitations or cessation should be taken into account when advising older drivers and developing alternative transportation strategies to help maintain their mobility Context Obstructive sleep apnea ( OSA ) is associated with sleepiness and poor concentration , symptoms that could impair driving performance . Contribution This study evaluated simulated driving performance in 38 patients with untreated OSA and 20 control participants under 3 conditions : unrestricted sleep , sleep restriction , and consumption of alcohol .  Compared with control participants , patients with untreated OSA had worse simulated driving performance .  Patients with OSA also had greater decrements in driving performance after sleep restriction and after alcohol consumption . Implication Consider alerting patients about the potential negative influence of untreated OSA on driving performance and their heightened vulnerability after sleep deprivation and alcohol consumption . The Editors Obstructive sleep apnea ( OSA ) causes excessive daytime somnolence and reduced vigilance , concentration , and neurocognitive function ( 1 , 2 ) . Patients with OSA , particularly those with moderate to severe disease , have a 2- to 7-fold increased risk for motor vehicle accidents ( 310 ) . Community surveys have shown that approximately 7 % of the middle-aged population has at least mild OSA ( > 10 obstructive events per hour of sleep ) ( 1113 ) , and up to 80 % of these cases are undiagnosed ( 1416 ) . For patients whose condition is diagnosed , delays in instituting treatment are common ( 17 ) . Between 46 % and 83 % of patients do not adhere to treatment over the long term ( 18 ) . The many patients with undiagnosed or untreated OSA represent a serious public health concern with respect to road safety . Accidents related to OSA result in an estimated 1400 road fatalities and cost $ 15.9 billion annually in the United States alone ( 19 ) . Improving access to diagnosis and treatment may help reduce this public health burden . However , even with improved sleep medicine services , many unidentified or untreated patients with OSA will probably remain at increased risk for motor vehicle accidents . A better underst and ing of the factors contributing to motor vehicle accidents among patients with OSA is therefore needed to develop cost-effective prevention strategies . This study was design ed to compare the effects of 2 common lifestyle factors , low-dose alcohol and acute partial sleep deprivation , on driving simulator performance between untreated patients with OSA and healthy matched control participants . We postulated that because of previous chronic sleep disruption and possible hypoxia-induced brain damage ( 2 , 2026 ) , patients with OSA would be more vulnerable to the effects of these common , mild central nervous system stressors and would experience significantly greater decrements in driving performance . Methods The study was approved by the Human Research Ethics Committees of the Repatriation General Hospital , University of South Australia , and University of Adelaide . Participants were introduced to the study objectives and protocol during an introductory session , gave written informed consent , and were remunerated for their participation . Study Design Patients with OSA and control participants underwent driving simulator assessment s under 3 conditions that were presented in r and om and counterbalanced order : after a normal nighttime sleep , after a single night of sleep restriction ( 4 hours in bed from 2:00 a.m. to 6:00 a.m. ) , and after acute administration of low-dose alcohol ( target blood alcohol concentration , 0.05 g/dL ) . All driving simulator sessions began at 2:00 p.m. and were conducted at least 5 days apart to avoid carryover effects from the previous interventions . Participant Selection Thirty-eight untreated patients with OSA of varying severity were recruited after diagnostic polysomnography .  Neither they nor their referring physician had specific concerns about their driving . To minimize selection bias , patients were told that the study objective was to investigate general neurocognitive performance ; they were unaware that the trial measured driving performance until after they agreed to attend an introductory session . Twenty healthy control participants matched for age and sex were recruited from the general population through newspaper advertisements , which only generally described the study and did not mention driving performance measures . Exclusion criteria were employment as a professional driver or shift worker ; history of driving less than 2 years or less than 2 hours per week ; notable medical comorbid conditions ( such as cardiac or respiratory failure ) , periodic limb movement disorder ( periodic limb movement arousal index > 5 per hour ) , or past head injury or depression ; use of alertness-altering prescription medications that may change neurocognitive function ( such as antihistamines , opiates , or antidepressants ) ; and history of alcohol abuse or current use of recreational drugs . Control participants were also excluded if they had higher-than-normal scores on sleep quality and daytime drowsiness question naires . Baseline Measures Before the driving simulator assessment , all participants completed question naires that evaluated general health ( medical conditions , medication , alcohol intake , caffeine 
    Output:
    
No significant impact of regular therapeutic opioid agonists on people ’s driving-related psychomotor skills was reported .