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PubMed1991

Bioptic telescopic spectacles for motor vehicle driving.

Attaining independent daily living skills is the primary functional goal of low vision rehabilitation. One of the most important of these skills is the ability of the low vision patient to achieve independent travel. In many geographical areas, automobile driving is the only available means of transportation. The utilization of a bioptic telescopic spectacle (BTS) provides a mechanism for some visually impaired individuals to qualify for a driver's license. However, the use of bioptic telescopic spectacles for driving is an extremely complex and controversial issue. An overview of the current status of the driving laws in various states, the accident rates of bioptic telescopic drivers, and various alternative proposals for motor vehicle licensure for the visually handicapped will be discussed.

Automobile Driver Examination↗
PubMed2006

Factors affecting recovery and discharge following ambulatory surgery.

PURPOSE: Recovery and discharge following ambulatory surgery are important components of the ambulatory surgery experience. This review provides contemporary perspectives on the issues of discharge criteria, fast-tracking, patient escort requirements, and driving after ambulatory anesthesia. SOURCE: A search was performed in the Cochrane Central Register for Controlled Trials, MEDLINE(R), EMBASE(R), CINAHL, and PsycINFO, to review factors delaying discharge following ambulatory surgery. The following subject headings were used: "ambulatory surgery, discharge, recovery, car driving, escort, transport, fast tracking, patient discharge, recovery, transportation of patients, hospital discharge, recovery room, patient transport, hospital discharge, recovery room, anesthetic recovery, patient transport, ambulatory surgical procedures, patient discharge, recovery of function, automobile driving, patient escort service, recovery room". Using the same search engines, the following keywords were used: "fast tracking, recovery, and discharge". PRINCIPAL FINDINGS: The current literature supports that discharge scoring systems may be useful to guide discharge following ambulatory surgery. While fast-tracking has become common in some centres, further studies are required to justify more routine implementation of this practice in the management of patients undergoing ambulatory surgery. Patients at low risk for urinary retention can be discharged home without voiding. Patients should not drive until at least 24 hr postoperatively. CONCLUSIONS: Ensuring rapid postoperative recovery and safe discharge following ambulatory surgery are important components of the ambulatory surgical program. A clearly defined process should be established for each ambulatory surgical unit to ensure the safe and timely discharge of patients after anesthesia, in accordance with current best evidence.

Ambulatory Surgical Procedures↗
PubMed2004

Driver route-following and safety errors in early Alzheimer disease.

OBJECTIVE: To assess navigation and safety errors during a route-following task in drivers with Alzheimer disease (AD). DESIGN/METHODS: Thirty-two subjects with probable AD (by National Institute of Neurological and Communicative Disorders criteria) of mild severity and 136 neurologically normal older adults were tested on a battery of visual and cognitive tests of abilities that are critical to safe automobile driving. Each driver also performed a route-finding task administered on the road in an instrumented vehicle. Main outcome variables were number of 1) incorrect turns; 2) times lost; and 3) at-fault safety errors. RESULTS: The drivers with mild AD made significantly more incorrect turns, got lost more often, and made more at-fault safety errors than control subjects, although their basic vehicular control abilities were normal. The navigational and safety errors were predicted using scores on standardized tests sensitive to visual and cognitive decline in early AD. CONCLUSIONS: Drivers with Alzheimer disease made more errors than neurologically normal drivers on a route-following task that placed demands on driver memory, attention, and perception. The demands of following route directions probably increased the cognitive load during driving, which might explain the higher number of safety errors.

Aged↗
PubMed2003

International policies on alcohol impaired driving: are legal blood alcohol concentration (BAC) limits in motorized countries compatible with the scientific evidence?

Borkenstein et al. (1974) study indicated that drivers with BACs of 0.05 to 0.09 per cent were twice as likely to crash as drivers with a zero BAC. Drivers with BACs from 0.10 to 0.14 per cent were ten times as likely to have a fatal crash in 1964. There have been numerous efforts during the history of motorized countries to control the consumption of alcohol and the problems associated with it through legislative mandate, it was not until the 1970s that acceptance of legal BAC (Blood Alcohol Concentration) limits laws became widespread. In particular, as more and more people drive automobiles, the number of traffic accidents involving drunken drivers has soared, and many of these are known to be related to the consumption of alcohol. Thus, legislators find themselves under increasing pressure to find a reasonable and fair solution to the question of alcohol impaired driving, as the scientific evidence about alcohol consumption level and psycho motor functions impairment came to clear. A landmark event in the development of policies regarding impaired driving was the establishment of the fact that consumption of alcohol does, in fact, increase the probability of traffic crashes. Legal limit laws specify a maximum permissible BAC limit for drivers. Currently, a BAC laws range from zero tolerance and 0.02 to 0.10% constitutes prima facie evidence in most countries for 'Driving under Influence of Alcohol.' This latter standard is too permissive, as driving skills deteriorate and crash involvement risk increases beginning at 0.02%. There are consequences attached to setting a BAC limit so high that a 72 kg man can drink five bottles of beer and still be under legal limit. In this sense high legal BAC limit may influence people to make bad estimates of their relative risk of injury or death while driving. Provided there is adequate political will, millions of lives could be saved in the coming years. This review is an attempt to examine in detail the available information about legal BAC limit laws, and issue of considerable interest to both policy makers and the public.

Accidents, Traffic↗
PubMedDate not supplied

[EEG and success in learning the job of autotransport driver in persons with different typologic characteristics of the nervous system].

The properties of nervous processes: mobility and strength (capacity for work), were determined by the Khilchenko method in healthy subjects learning the trade of an automobile driver. People with different individual typological characteristics of higher nervous activity displayed significant differences in EEG energo-frequency parameters of different brain areas. It has been shown that EEG of practically healthy people at rest, in conjunction with other informative psycho-physiological data, offers promise for appraising the individual typological characteristics of a person in predicting the professional suitability for driving automobiles.

Adult↗
PubMed2002

Driving accident frequency increased in patients with multiple sclerosis.

OBJECTIVES: To assess the influence of multiple sclerosis (MS) on the ability to drive safely. MATERIAL AND METHODS: A 10-year historical cohort register-study on 197 patients with MS and 545 controls individually matched on age, gender, place of residence, and exposure period. Persons with other neurological diseases, diabetes or abuse were excluded. The outcome measure was treatment at the emergency department after accident as a car driver. RESULTS: Five patients and four controls had been treated, the rate per 1000 person-years with exposure being 3.4 times higher (CI 0.73-17.15) in the patients than in the control cohort. The difference is significant in one-sided test (P=0.04). CONCLUSION: Drivers with MS were treated more often than healthy controls at a casualty department after having a road traffic accident. However, drastic consequences regarding the patients automobile driving should be avoided until these results have been substantiated by further investigations.

Accidents, Traffic↗
PubMed2002

[Increased frequency of driving accidents in epilepsy].

INTRODUCTION: The influence of medical conditions on the ability to drive safely is a matter of concern to both physicians and society. Satisfactory answers to the many questions are not yet available, because of methodological difficulties, including the inability to collect sufficiently large and representative samples of drivers with specific diseases, and to acquire reliable accident data. For epilepsy, the conclusions of scientific reports vary from "there is little to worry about" to an increased relative risk of 1.9. As a consequence, attitudes and regulations vary greatly throughout the world. MATERIAL AND METHODS: A ten-year historical cohort register study of 159 patients with epilepsy and 559 controls individually matched for age, gender, place of residence, and exposure period. Recorded diagnoses of other relevant diseases led to exclusion. The outcome measure was treatment at the casualty department after an accident as a car driver. RESULTS: Ten patients and five controls had been treated at the casualty department, the rate ratio per 1,000 person-years with exposure being 7.01 (CI 2.18-26.13). DISCUSSION: This study showed that drivers with epilepsy seven times more often than healthy controls were treated at a casualty department after having a road traffic accident. In view of the small numbers of accidents and the surprising findings, the results must be interpreted cautiously. It is not advisable at this time to liberalize demands, but, on the other hand, drastic inferences regarding the patients' automobile driving should be avoided until the results have been further substantiated.

Accidents, Traffic↗
PubMed2002

Physiological responses to high-speed, open-wheel racecar driving.

UNLABELLED: High-speed auto racing has been demonstrated to produce accelerated heart rate (HR) during competition. However, it has not been determined whether the increase in HR was due to physical work efforts or a result of emotional stress. PURPOSE: The purpose of this investigation was to examine the physiological responses associated with open-wheel automobile driving at competitive speeds. METHODS: Oxygen consumption and HR were assessed in seven professional automobile racing drivers during two incrementally paced driving sessions. A portable metabolic analyzer and EKG were directly attached to the subjects as they participated in driving tests on an oval speedway and a roadway course. Maximal physiological responses of the subjects were also determined during a graded treadmill test. RESULTS: During treadmill testing, maximal oxygen consumption (VO2max) ranged from of 42.0 to 59.7 mL x kg(-1) x min(-1) (mean +/- SD = 47.6+/-8.1). The road course and oval speedway testing at competitive speeds elicited mean VO2 values of 38.5 and 21.9 mL x kg(-1) x min(-1), respectively, which correspond to 79% and 45% of VO2max. Road course driving produced mean HR values of 152 beats x min(-1) with 142 beats x min(-1) recorded when driving at competitive speed on the speedway course. CONCLUSIONS: Professional open-wheel race drivers possess cardiorespiratory capacity similar to athletes participating in sports such as basketball, football, and baseball. The VO2 and HR responses to road course driving were similar to those previously reported in traditional sports settings. The findings of this study suggest that professional open-wheel racing drivers should be regarded as athletes that encounter significant physiological stresses.(2)

Adaptation, Physiological↗
PubMed1996

Effects of prolonged autovehicle driving on male reproduction function: a study among taxi drivers.

This study had the purpose of exploring the possible association between the work exposures of professional drivers and their reproductive health, by studying a group of 201 taxi drivers in the city of Rome. Data on work and reproductive history were collected by interviews. Biological markers examined in 72 subjects included salivary testosterone levels, sperm quality (i.e., sperm concentration, sperm morphology, and motility), and fertility experience, including time to pregnancy. Their spermatologic profile was compared with that of a control group of 50 healthy subjects of similar age and smoking habits. The results showed that taxi drivers, compared to the controls, had a significantly lower prevalence of normal sperm forms (45.8% vs. 64.0%); this was particularly true for those with a longer time on this job. This result was confirmed by a multivariate analysis in which confounders such as age, smoking, and alcohol consumption were controlled. The other sperm parameters did not differ in the study and the control groups. Among the life-style factors, we found smoking to be associated with poorer sperm morphology. Moderate alcohol consumption was associated with a better seminologic profile, while the pattern in respect to coffee intake was inconclusive. Subjects with poor semen quality also more frequently exhibited longer time to pregnancy of their partner. The results suggest that prolonged urban automobile driving might be a risk factors for sperm quality, and particularly for sperm morphology, but the finding needs further confirmation.

Adult↗
PubMedDate not supplied

The myth of "the average alcohol response".

The human alcohol response literature often states or implies that there is little variation among normal individuals in their responses to a standard dose. To test this assumption, a wide variety of alcohol responses was reviewed in studies where the original, individual responses were available. All such responses showed variability among individuals. Seven alcohol responses (individual changes from pre-alcohol baseline in heart rate, systolic and diastolic blood pressure, automobile driving ability, and three tests for intoxication) in normal males are analyzed in detail. Each response shows marked, significant individual variability. Genetic differences among individuals (in addition to environmental differences) are probably important in producing this variability. Since normal persons can vary greatly in their alcohol responses, it is not only incomplete but misleading to give only the mean value. Information on the range and frequency distribution of responses is also needed.

Adult↗
PubMed1976

Painless ST-segment depression in patients with angina pectoris. Correlation with daily activities and cigarette smoking.

Ambulatory electrocardiographic monitoring was employed in 33 patients with angina pectoris and abnormal stress tests to determine the frequency with which myocardial ischemia manifested by painless ST-segment depression occurred during normal activity. ST-segment depression occurred in 24 patients during the monitoring period; and in 21, it occurred either solely in the absence of pain or both with and without pain. Of 109 recorded episodes of ST-segment depression, 61 percent were painless. The frequency of painless ST-segment depression was independent of activity other than automobile driving, during which all episodes were painless. In patients who smoked cigarettes, ST-segment depression was more common while smoking, but the incidence of painless ST-segment depression was not altered. The study indicates that ST-segment depression occurs more commonly in the absence than in the presence of chest pain and that ambulatory electrocardiographic monitoring is a useful method of determining the frequency of myocardial ischemia during normal daily activity.

Adult↗
PubMed2002

An immersive simulation system for provoking and analyzing cataplexy.

Cataplexy, a sudden loss of voluntary muscle control, is one of the hallmark symptoms of narcolepsy, a sleep disorder characterized by excessive daytime sleepiness. Cataplexy is usually triggered by strong, spontaneous emotions, such as laughter, surprise, fear or anger, and is more common in times of stress. The Sleep Disorders Unit and the Biomedical Imaging Resource at Mayo Clinic are developing interactive display technology for reliably inducing cataplexy during clinical monitoring. The use of immersive displays may help bypass patient defenses, and game-like "unreality" allows introduction of surprising, threatening, or humorous elements, with little risk of offending patients. The project is referred to as the "Cataplexy/Narcolepsy Activation Program", or CatNAP. We have developed an automobile driving simulation to allow the introduction of humorous, surprising, or stress-inducing events and objects as the patient attempts to navigate a simulated vehicle through a virtual town. The patient wears a stereoscopic head-mounted display, by which he views the virtual town through the windows of his simulated vehicle. The vehicle is controlled via a driving simulator steering wheel and pedal cluster. The patient is instructed to drive his vehicle to another location in town, given initial directions and street signs. As he attempts to accomplish the task, various objects, sounds or conditions occur which may distract, startle, frustrate or cause laughter; responses which may trigger a cataplectic episode. The patient can be monitored by reflex tests and EMG recordings during the driving experience. An evaluation phase with volunteer patients previously diagnosed with cataplexy has been completed. The goal of these trials was to gain insight from the volunteers as to improvements that could be made to the simulation. All patients that participated in the evaluation phase have been under a physician's care for a number of years and control their cataplexy with medication. We believe this is a novel and innovative approach to a difficult problem. CatNAP is a compelling example of the potentially effective application of virtual reality technology to an important clinical problem that has resisted previous approaches. Preliminary results suggest that an immersive simulation system like CatNAP will be able to reliably induce cataplexy in a controlled environment. The project is continuing through a final stage of refinement prior to conducting a full clinical study.

Automobile Driving↗
PubMed1983

Some effects of emotion on the normal and abnormal heart.

Increased heart rate and catecholamine secretion are induced by certain emotions. Automobile driving in busy city traffic, racing driving, speaking before an audience, and parachute jumping are associated with sinus tachycardia 120-180 per minute, and increase in the plasma levels of adrenaline and/or noradrenaline. Electrocardiographic changes, chiefly ST depression, may occur in a small proportion of persons without ischemic symptoms and with normal resting tracings. Patients with clinical coronary disease, angina, and ischemic ST changes and arrhythmias may be induced by the emotional stimuli associated with car driving and public speaking; plasma catecholamine levels are increased in proportion to the intensity of the stimulus. beta-blockade reduces the tachycardia, and prevents in whole or in part the ST changes, arrhythmia and symptoms associated with emotional challenge to the heart. We would like to leave the reader with a final morsel of food for thought. Emotion may parallel exercise in its ability to accelerate the heart rate up to 180 per minute in healthy subjects, comparable to the maximum reached during physical exertion. Thus, there are good grounds to advise persons at risk not only against violent exercise but also against exposing themselves to intense emotion. At the same time, we would not advocate emotional overprotection, and we believe our ideas would be misinterpreted if healthy persons were to be deterred on the grounds of apprehension or nervousness from facing up to reasonable everyday professional or social challenges.

Adult↗