Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Drive”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 271 records · Page 15Linked to original sources
PubMed2001

Relationship between obstructive sleep apnoea, driving simulator performance, and risk of road traffic accidents.

BACKGROUND: Obstructive sleep apnoea (OSA) has been shown to be associated with an increased risk of road traffic accidents (RTAs). Predicting the driving ability and risk of RTAs in an individual with OSA is difficult. On-road testing is the gold standard, but this is time consuming, expensive, and potentially dangerous. Simple computer based driving simulators have been developed to help determine driving ability. Although patients with OSA have been shown to perform poorly compared with matched controls, it is not known whether these simulators can predict those at most risk of accidents. In this study we evaluated whether data derived from a simple driving simulator provided information over and above that obtained from the history and a sleep study that might be useful for advising patients about driving. METHODS: We examined 150 patients admitted for routine sleep studies for investigation of OSA and snoring. Each patient performed a 20 minute driving simulation and completed a questionnaire regarding their driving history and experience. RESULTS: Logistic regression analysis was used to investigate factors associated with patients' performance on the simulator. It was found that patient characteristics, older age (OR 1.05, 95% CI 1.01 to 1.09, p<0.01), female sex (OR 9.32, 95% CI 1.09 to 79.4, p<0.04), and self-reported alcohol consumption (OR 1.04, 95% CI 1.01 to 1.07, p<0.01) had the greatest influence; however, the number of self-reported near miss accidents was independently associated with a poor performance (OR 2.62, 95% CI 1.00 to 6.88, p<0.05). A further logistic regression was used to investigate whether clinical history, sleep study results, and data from the driving simulator were useful in classifying patients with OSA as having had an RTA. The number of off-road events per hour on the simulator was independently associated with a history of previous RTA (OR 1.004, 95% CI 1.0004 to 1.008, p<0.03). The Epworth score was independently associated with episodes of falling asleep at the wheel (OR 1.21, 95% CI 1.12 to 1.31, p<0.00001) and near miss accidents (OR 1.15, 95% CI 1.07 to 1.23, p<0.0001). Using this model, 100% of patients who did not have an accident could be identified, but only 10% of those who did. CONCLUSIONS: Although factors not directly related to OSA influence performance on a driving simulator, there is an independent relationship between driving ability in patients with OSA and performance on a simple computer based simulator. When combined with clinical history, it is those not reporting hypersomnolence and not having off-road events on the simulator who appear to be at least risk of adverse driving events. Poor performance on the simulator, however, relates poorly to accident history. These data require confirmation in future studies before simple computer simulators can be used in clinical practice to advise whether an individual is safe to drive.

Accidents, Traffic↗
PubMed2003

Fitness to drive with neurological disabilities.

To restore the ability to drive is one aim of the rehabilitation of patients with neurological disabilities. In some instances, an evaluation is required to judge a patient's fitness to drive in today's traffic. Forty-three patients of the neurorehabilitation unit of the Valens Clinic were assessed by a standard traffic psychological test protocol and a control drive. In 88%, there was agreement between the judgments based on each procedure. Four patients had failed either the psychological tests or the control drive but not both. Six patients had failed the psychological test and the control drive. Two drove nevertheless, and three patients stopped driving. Nineteen of 32 patients cleared to drive were followed up. Eleven drove without accidents or traffic fines. The traffic psychological tests and control drive yield complementary information on the fitness to drive. However, the assessments need to be improved. New generations of interactive driving simulators may refine the fitness to drive evaluation and become useful tools in driving rehabilitation.

Accidents, Traffic↗
PubMed2002

Outlets, drinking and driving: a multilevel analysis of availability.

OBJECTIVE: This study examines the degree to which the physical availability of alcohol as measured by outlet densities is related to self-reported individual drinking patterns, preferred drinking location, as well as both driving after drinking (DAD) and driving while intoxicated (DWI). METHOD: Data from 7,826 drinkers were obtained from a general-population telephone survey of 1,353 zip code areas in California. Measures of individual alcohol consumption included drinking frequency, drinks per occasion and variance in quantities consumed per occasion. Preferred drinking locations included bars, restaurants and the homes of drinkers and of their friends. DAD was defined as driving a motor vehicle within 4 hours of having one or more alcoholic drinks, and DWI was defined as driving after having too much to drink and drive safely. Geographic measures of outlet densities were obtained for bars, restaurants and off-premises establishments, using zip codes as geographic units of analysis. Hierarchical linear modeling was used to relate outlet densities within and surrounding respondents' area of residence to respondents' drinking and to respondents' drinking and driving. RESULTS: Whereas restaurant densities were directly related to greater drinking frequencies and DAD, bar densities were inversely related to DAD. There were no direct effects of drinking patterns on drinking and driving. Drinking and driving was strongly related to drinking location preference (e.g., bars and restaurants) only when considered simultaneously with individual drinking patterns, particularly drinking frequency. CONCLUSIONS: Increased restaurant density is strongly related to higher rates of both self-reported driving after drinking and drinking frequency. The strongest influence on both driving after drinking and driving while intoxicated is preferred drinking location considered together with individual drinking patterns. Outlet density and preferred drinking location when considered together with individual drinking patterns support driving after drinking and thereby increase the potential for alcohol-related accidents.

Adult↗
PubMed2005

Drink-driving and DUI recidivists' attitudes and beliefs: a longitudinal analysis.

OBJECTIVE: Cross-sectional survey research has shown correlations between drink-driving behavior and people's beliefs concerning the riskiness, social acceptability and morality of driving under the influence of alcohol. The current study examines the association between such beliefs and subsequent alcohol-impaired driving in a sample of offenders who were driving under the influence (DUI). METHOD: Repeated interviews were conducted with 182 multiple DUI offenders. Baseline data included measures of moral and prescriptive beliefs concerning alcohol-impaired driving (internal behavioral controls), perceived risks of criminal punishment and crashes associated with alcohol-impaired driving (external behavioral controls) and perceived peer-group attitudes toward alcohol-impaired driving (social control). The dependent variable in the study was a measure of self-reported alcohol-impaired driving over the preceding 2 years, collected at 2-year follow-up from baseline. RESULTS: Results from multiple regression modeling showed significant protective effects associated with the beliefs that driving after drinking is immoral and that random police sobriety checks are a good idea (internal control items). Results also showed that a social desirability control measure was predictive of increased risk, at follow-up, for driving after drinking. CONCLUSIONS: These results suggest that internal controls may protect against alcohol-impaired driving behavior, even in a high-risk sample of repeat DUI offenders. The results also suggest that future policy interventions to curtail drink-driving might profitably be designed to promote these sorts of behavioral controls.

Adult↗
PubMed2000

Progressive hypoglycemia's impact on driving simulation performance. Occurrence, awareness and correction.

OBJECTIVE: Progressive hypoglycemia leads to cognitive-motor and driving impairments. This study evaluated the blood glucose (BG) levels at which driving was impaired, impairment was detected, and corrective action was taken by subjects, along with the mechanisms underlying these three issues. RESEARCH DESIGN AND METHODS: There were 37 adults with type 1 diabetes who drove a simulator during continuous euglycemia and progressive hypoglycemia. During testing, driving performance, EEG, and corrective behaviors (drinking a soda or discontinuing driving) were continually monitored, and BG, symptom perception, and judgement concerning impairment were assessed every 5 min. Mean +/- SD euglycemia performance was used to quantify z scores for performance in three hypoglycemic ranges (4.0-3.4, 3.3-2.8, and <2.8 mmol/l). RESULTS: During all three hypoglycemic BG ranges, driving was significantly impaired, and subjects were aware of their impaired driving. However, corrective actions did not occur until BG was <2.8 mmol/l. Driving impairment was related to increased neurogenic symptoms and increased theta-wave activity. Awareness of impaired driving was associated with neuroglycopenic symptoms. increased beta-wave activity, and awareness of hypoglycemia. High beta and low theta activity and awareness of both hypoglycemia and the need to treat low BG influenced corrective behavior. CONCLUSIONS: Driving performance is significantly disrupted at relatively mild hypoglycemia, yet subjects demonstrated a hesitation to take corrective action. The longer treatment is delayed, the greater the neuroglycopenia (increased theta), which precludes corrective behaviors. Patients should treat themselves while driving as soon as low BG and/or impaired driving is suspected and should not begin driving when their BG is in the 5.0-4.0 mmol/l range without prophylactic treatment.

Adult↗
PubMed2000

Relationship of laboratory and on-road tests for driving-school students and experienced drivers.

There is a pressing need to evaluate driving ability without an actual driving test but no reliable, standardised procedure is available. This study investigated the resulting distortion performance evaluation for different driver groups in on-road tests due to driving skills and driving style. Two groups, 15 female driving school students and 25 experienced male drivers were examined using cognitive and psychomotor tests and standard personality questionnaires as well as an on-road driving test. The students made significantly fewer errors on the driving test than the experienced drivers. The former group's driving performance could be predicted by errors on the laboratory tests, along with personality factors, while experienced drivers' driving errors were best predicted by slowness on laboratory tests. This study suggests that, when a series of standard cognitive and psychomotor tests are considered, different measures may apply in predicting young people's ability to drive safely based on assessing driving ability of experienced drivers, assumed lowered due to distorted driving style.

Adolescent↗
PubMed1994

[A survey of the improvement of public transportation for the elderly. Reasons for giving up driving by retired automobile workers living in in Kanagawa Prefecture].

In order to improve the adequacy and safety of transportation for elderly people, the reasons for, and the after-effects of stopping driving by elderly people were analyzed. The subjects consisted of 500 car manufacturing retirees, aged 60 years old and over, living in Kanagawa prefecture. Of the 500 people questioned, 298 people (59.6%) responded. Of these 196 currently held licences. In this group, 149 still drove, 9 intended to stop driving soon, and 38 had already stopped. Of the 38 people who had already stopped driving, 7 quit before age 55. These people were omitted from analysis because factors other than aging possibly contributing to their stopping driving. We were interested in the 31 people older than 55 and the 9 people who intended to quit soon. The results were the following: I) The main reasons why they had stopped driving were the following: a) anxiety felt because of decreased driving ability and the feeling to need to walk in order to improve their health; b) the needlessness of driving because of availability of other means of transportation; II) The anxiety from decreased driving ability correlated with difficulty with narrow roads and imparied vision making it difficult to observed road signs; III) The reasons for stopping driving correlated with the effects: the needlessness of driving because of use of other means of transportation correlated with decreased frequency of going out for hobby and group activities. These results show that stopping driving also affects the social activities of the Japanese elderly. It was concluded that we should inform the elderly drivers of the effects of stopping driving as well as improving conditions on roads and comfort in automobiles.

Aged↗
PubMedDate not supplied

Identifying older drivers at risk of traffic violations by using a driving simulator: a 3-year longitudinal study.

OBJECTIVES: This prospective longitudinal study aims to determine which simulated driving tasks of a personal computer (PC)-based driving simulator can be used to identify problematic older drivers, using their 3-year driver violation points record as the outcome measure. METHODS: A total of 129 urban community-dwelling older drivers volunteered to participate in the study. Using a driving simulator, specific driving tasks were devised to test the performance of older drivers. Their officially recorded driver violation points were retrieved immediately after the simulated driving assessment and thereafter for the following 2 years. Self-reported driving records were also collected during the same period. Hierarchical Poisson regression analysis, adjusting for gender, age, and driving exposure (hours of driving per week), was then undertaken to determine those driving tasks that affected the frequency of traffic violations. RESULTS: All participants incurred at least one driver violation point during the 3-year period. The simulated driving tasks found to be significantly associated with the incidence of traffic violations were working memory and use of indicator. CONCLUSIONS: This longitudinal study demonstrated that the driving simulator was able to identify unsafe older drivers at risk of traffic violations if appropriate simulated driving tasks were used. Such a screening tool should be adopted prior to administering a more detailed but expensive road test.

Accidents, Traffic↗
PubMed2002

The development and clinical trial of a Driving Simulator for the handicapped.

We developed a Virtual Reality Driving Simulator in order to safely evaluate and improve the driving ability of the handicapped. The Virtual Environment consists of 18 sections (e.g. a speed limited road, a strait road, a curved road, a left turn course, etc) and each section is linked naturally. For the interface of our driving simulator, an actual car was adapted for realism and then connected to a computer. We also equipped it with hand control driving devices especially adapted for the handicapped. A beam projector was used so that the subjects could see the virtual scene on a large screen which was set in front of them. The subjects selected for this trial were 10 normal drivers with valid driving licenses and 15 patients with thoracicor lumber cord injuries who had prior driving experience. For evaluation, 5 driving skills were measured including average speed, steering stability, centerline violations, traffic signal violations, and driving time in various road conditions such as strait and curved roads. The normal subjects manipulated the gas pedal and the brake with their feet while the patients manipulated a hand control with their hands. After they finished driving the whole course, the participants answered the questions such as "How realistic did the Virtual Reality Driving Simulator seeme to you?" and "How much was your fear reduced". The five driving skills measured between the two groups (normal vs. handicapped) did not show any significant differences (p > 0.05). And in the three kinds of road conditions (a speed limited road and roads with a sharp curve and left-hand turn), the average speed of the handicapped group was 45.6 Km, less than 61.2 Km (p<0.05) of the normal group. In all, 11 patients (73%) reported that their fear of driving was reduced. Furthermore, their average score on the degree of realism question was 51.5%.

Adult↗
PubMed1995

Perceived and actual risks of driving in patients with arrhythmia control devices.

BACKGROUND: We surveyed patient attitudes about driving and about driving restrictions for patients with automatic defibrillators and pacemakers, and we assessed risk of arrhythmias occurring during driving. METHODS: One hundred two patients responded to a questionnaire (57 patients with defibrillators and 45 patients with pacemakers) about driving habits and opinions on restriction of patients who have devices and want to drive. In addition, the literature was reviewed for approximate incidences of sudden death and syncopal or nonsyncopal device therapy to estimate risk while driving of having a defibrillator discharge. RESULTS: Thirty-two patients with defibrillators (56%) and 28 patients with pacemakers (62%) currently drove an average of 196 and 161 km/wk, respectively. Most patients felt that driving was a right and 75% felt that restriction imposed a hardship on them. Respondents felt that common sense, limited distances, or physician input should set driving limitations. A minority felt that no restrictions should be placed on these drivers or that they should not drive at all. The risks of sudden death and syncopal and nonsyncopal defibrillator discharge were estimated at 0.0009%, 0.0011%, and 0.0015% per kilometer driven, respectively, based on weekly kilometers and published occurrences of these phenomena. CONCLUSIONS: Patients perceive that driving is their right and that there is a low risk of an arrhythmic event behind the wheel. The estimated risk and published accounts of sudden death support this. However, concurrent medical problems and stresses imposed by driving may increase risk. The physician must make reasonable recommendations to ensure patient and public safety, keeping in mind both state and federal driving regulations and reporting requirements.

Aged↗
PubMed1992

Effect of pacing drive cycle length on induction of sustained monomorphic ventricular tachycardia.

To assess the effect of pacing drive cycle length on induction of sustained monomorphic ventricular tachycardia, 40 patients were prospectively studied in the drug-free state. Ventricular extrastimuli were sequentially delivered at the same coupling interval at each of three drive cycle lengths (600, 500, and 400 ms) before the coupling interval was shortened and the process repeated. This protocol was continued until sustained monomorphic ventricular tachycardia was induced at all three drive cycle lengths or until pacing was completed through three extrastimuli. Of the 27 patients in whom sustained monomorphic ventricular tachycardia was induced, tachycardia was induced at all 3 drive cycle lengths in 12 (44%), only 2 drive cycle lengths in 11 (41%), and only 1 drive cycle length in 4 (15%) patients. Although the yield of inducible ventricular tachycardia increased with each additional extrastimulus, this yield increased even further with the use of multiple drive cycle lengths. In 10 of 11 patients, failure to induce ventricular tachycardia at any drive cycle length was not due to failure to achieve at that drive cycle length the critical extrastimulus coupling interval required to induce tachycardia at other drive cycle lengths. Induction of sustained monomorphic ventricular tachycardia is often drive cycle length specific, and failure to induce tachycardia cannot be explained by failure to achieve critically short coupling intervals. Pacing at multiple drive cycle lengths increases the yield of induced ventricular tachycardia.

Cardiac Pacing, Artificial↗
PubMed1996

Neuropsychological driving fitness tests for brain-damaged subjects.

OBJECTIVES: The study was carried out to evaluate and develop simple tools to assess the driving fitness of brain-damaged patients. DESIGN: Four neuropsychological tests (predictors) were validated against an open-road driving test (criterion standard), which is used by the Department of Adaptations of the Dutch Driving Licensing Agency for assessing disabled drivers. SETTINGS: The predictor tests were conducted in the involved scientific institute; the criterion standard involved participation in normal traffic. PATIENTS: The subject group consisted of 33 men and 5 women who had recovered to a stabilized level from traumatic brain injuries. All had valid driving licenses when they were injured and they were considered to be potentially able to recommence driving. The subjects had a mean reported driving experience of 109.200km (SD = 86.300km). All subjects were recovered from a brain trauma with an average coma duration of 33 days (SD = 51 days). They were tested at least 1 year after the accident. All the subjects had normal or corrected-to-normal vision and none used medications that, according to existing medical criteria, interfere with normal psychomotor or cognitive functioning. Ages at the time of the injury were between 17 and 55 years (mean, 29.8; SD, 10.9). MAIN OUTCOME MEASURES: Pearson product moment correlations (and explained variances) were calculated between the four predictor tests (a Perceptual Speed test, the WAIS Symbol-Digit Substitution subtest, a Tracking-Reaction dual task, and a Time Estimation task) and the open-road criterion standard. RESULTS: The results indicated that performance on both the Perceptual Speed task and the Time Estimation task were significantly correlated with driving performance (p < or = .05). When combined with coma duration and driving experience, the Perceptual Speed and Tracking-Reaction tests together explained 35.3% (r = .59) of the variance in on-road driving performance. CONCLUSIONS: The amount of variance in open-road driving performance that could be accounted for by these tests was insufficient to completely replace an open-road driving fitness assessment. Also, based on other experimental documentation, it is concluded that more integral, domain-specific test (eg, based on driving simulation) need to be developed.

Adolescent↗
PubMed1999

Effect of whole-body vibration on the low back. A study of tractor-driving farmers in north India.

STUDY DESIGN: A retrospective cohort study of tractor-driving farmers (study group) and non-tractor-driving farmers (control group) matched for age, gender, generic/ethnic group, land-holding, and work routines. OBJECTIVES: To determine, using magnetic resonance imaging and clinical investigations, the effect of whole-body vibrations on the back in tractor-driving farmers. SUMMARY OF BACKGROUND DATA: Low back pain and pathologic changes in the lower backs of tractor drivers have been reported. However, no study with a control group matched for work-related risk factors has been reported. METHODS: Fifty tractor-driving farmers were compared with 50 non-tractor-driving farmers matched for age, gender, ethnic group, land-holding, and work routine. Both groups were interviewed for details of work routine, assets held, family profile, and vibration exposure to assess the influence of these parameters on signs and symptoms of backache. Magnetic resonance imaging was done to assess the effect of exposure on whole-body vibration and degenerative changes in the back. Vibration measurements also were done on tractors to observe the actual severity of the vibrations. RESULTS: Regular work-related backache was more common among tractor-driving farmers (40%) than among non-tractor-driving farmers (18%, P = 0.015). Anthropometric evaluation showed abdominal girth and weight to be significantly higher in tractor-driving farmers (P = 0.006 and 0.046, respectively), whereas while height and arm span were similar between the two groups. Clinical examination for evidence of disc or facet degeneration showed no difference between the two groups. Evaluation of magnetic resonance images of tractor-driving farmers and non-tractor-driving farmers by an orthopedic surgeon, radiologist, and neurosurgeon showed degenerative changes to be similar between the two groups (P > 0.050). CONCLUSIONS: Tractor-driving farmers report backache more often than non-tractor-driving farmers, but no significant objective differences on clinical or magnetic resonance imaging evaluation were found between the two groups.

Adult↗
PubMed1990

Excitatory amino acid-mediated transmission of inspiratory drive to phrenic motoneurons.

1. The role of excitatory amino acids (EAAs) in the bulbospinal transmission of inspiratory drive was studied by intracellular and single-electrode voltage-clamp recordings from phrenic motoneurons in the in vitro neonatal rat brain stem spinal cord. 2. In all brain stem-spinal cord preparations there were spontaneously generated rhythmic membrane depolarizations and associated spiking of phrenic motoneurons during the inspiratory phase of the respiratory cycle. The envelope of the motoneuron drive potential had a rapid onset to peak (50 ms) followed by a plateau/declining phase that lasted 400-700 ms. The peak potential was approximately 10-20 mV above base-line potential. The drive current under voltage clamp had a similar shape and duration to the drive potential with a peak current greater than 1.5 nA. 3. The involvement of EAAs in the bulbospinal transmission of inspiratory drive was demonstrated by checking the effects of various EAA receptor antagonists on the phrenic motoneuron inspiratory drive. When kynurenic acid (KYN), an antagonist acting on all three subtypes of EAA receptors, was applied to the solution bathing the spinal cord, the motoneuron action potentials were abolished, and the amplitude of inspiratory drive potential was significantly reduced. To further classify the role of the different EAA receptor subtypes in the synaptic transmission of inspiratory drive, the effects on the drive potential of either 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX), a specific non-N-methyl-D-aspartic acid (non-NMDA) receptor antagonist, or DL-2-amino-5-phosphonovaleric acid (AP5), DL-2-amino-7-phosphonoheptanoic acid (AP7), and (+)-5-methyl-10,11-dihydro-5H-dibenzo[a,d]cyclohepten-5,10-imin emaleate (MK-801), NMDA receptor antagonists, were investigated. Bath or local application of CNQX induced a dose-dependent decrease of the inspiratory drive potential without changing intrinsic motoneuron membrane properties. On the other hand, application of AP7 or MK 801 had a small effect on the inspiratory drive potential or the inspiratory drive current when the motoneuron membrane potential was clamped near end-expiratory potentials (-60 to -75 mV). 4. To establish the presence of EAA receptors on the phrenic motoneuronal membrane and to provide information on the available receptor subtypes for action of the endogenously released transmitter, we tested the effects of agonists for the major EAA receptor subtypes after blocking synaptic transmission (produced by axonal action potentials) by bath application of tetrodotoxin (TTX).(ABSTRACT TRUNCATED AT 400 WORDS)

2-Amino-5-phosphonovalerate↗
PubMed2000

The preoptic area in the hypothalamus is the source of the additional respiratory drive at raised body temperature in anaesthetised rats.

In mammals that use the ventilatory system as the principal means of increasing heat loss, raising body temperature causes the adoption of a specialised breathing pattern known as panting and this is mediated by the thermoregulatory system in the preoptic area of the hypothalamus. In these species an additional respiratory drive is also present at raised body temperature, since breathing can reappear at low Pa,CO2 levels, when stimulation of chemoreceptors is minimal. It is not known whether the preoptic area is also the source of this additional drive. Rats do not pant but do possess this additional respiratory drive at raised body temperatures. We have therefore tested whether the preoptic area of the hypothalamus is the source of this additional respiratory drive in rats. Urethane anaesthesia and hyperoxia were used in eleven rats to minimise behavioural and chemical drives to breathe. The presence of the additional respiratory drive was indicated if rhythmic diaphragmatic EMG activity reappeared during hypocapnia (a mean Pa,CO2 level of 21+/-2 mm Hg, n = 11), induced by mechanical ventilation. The additional respiratory drive was absent at normal body temperature (37¿C). When the temperature of the whole body was raised using an external source of radiant heat, the additional respiratory drive appeared at 40.6+/-0.5 degrees C (n = 3). In two further rats this drive was induced at normal body temperature by localised warming in the preoptic area of the intact hypothalamus. The additional respiratory drive appeared at similar temperatures to those in control rats in three rats following isolation of the hypothalamus from more rostral areas of the brain. In contrast, the additional respiratory drive failed to appear at these temperatures in three rats after isolating the hypothalamus from the caudal brainstem, by sectioning pathways medial to the medial forebrain bundle. Since the preoptic area is known to contain thermoreceptors and to receive afferents from peripheral thermoreceptors, the results show that this area is also the source of the additional respiratory drive at raised body temperature in anaesthetised rats.

Anesthesia, Intravenous↗
PubMedDate not supplied

The metabolic demands of driving for drivers with type 1 diabetes mellitus.

BACKGROUND: The active cognitive-motor demands of driving may have a significant metabolic demand that could contribute to the development of hypoglycemia. Conversely, symptoms caused by the stress of driving may be confused with hypoglycemia and lead to false alarms. This study examined the metabolic demand and the physiological stress of driving on type 1 diabetes mellitus (T1DM) drivers. METHODS: Forty-three T1DM drivers were placed on a constant insulin infusion/variable dextrose infusion to maintain euglycemia for 30 min while either watching a driving video or actually driving a simulator, in a counterbalanced crossover design. Dextrose infusion, heart rate, epinephrine, and subjective symptom ratings were measured every 5 min. Additionally, subjects were monitored for self-treatment (drinking soda). RESULTS: While blood glucose (BG) levels were equivalent across both conditions, actual driving was associated with a higher dextrose infusion rate (p = 0.02), more autonomic symptoms (p < 0.05), increased heart rate (p < 0.001), a trend (p = 0.09) for greater epinephrine release, and more frequent hypoglycemic self-treatment (p < 0.001). CONCLUSIONS: Driving is a task with a significant metabolic demand, which may lower BG, and also that driving stress may be associated with symptoms similar to those of hypoglycemia. Physicians should discuss with their T1DM patients hypoglycemia and driving, and encourage measuring blood glucose before driving and during long drives.

Adult↗
PubMed2005

Impact of internal versus external cueing on driving performance in people with Parkinson's disease.

Numerous aspects of driving performance seem compromised in people with Parkinson's disease (PD). Measures of cognitive impairment consistently correlate with poor driving simulator performance in this population; however, the effects of specific cognitive difficulties on discrete aspects of driving behavior have not been investigated thoroughly. Previous studies have demonstrated that people with PD exhibit difficulties internally cueing cognitive processes. This study examined the impact of impaired internal cueing on specific driving behaviors. A simulator measured the driving behavior of 18 current drivers in the mild-to-moderate stages of PD and 18 matched controls. Participants navigated through different driving conditions where the opportunity to use internal and external cues was manipulated. People with PD exhibited difficulties using internal cues to regulate driving behavior around traffic signals and curves. Instead of using internal cues, participants with PD were more reliant on external cues to regulate driving behavior. They were also less able to adapt their driving behavior to suit driving conditions. Because all participants with PD were current drivers in the mild-to-moderate stages of the disease, findings challenge the widely-held assumption that cognitive difficulties only impact on driving performance in the moderate-to-severe stages of PD.

Accidents, Traffic↗
PubMed1994

Acrivastine, terfenadine and diphenhydramine effects on driving performance as a function of dose and time after dosing.

The study was conducted according to a nine-way, observer- and subject-blind, cross-over design. Its purpose was to compare the single-dose effects of the following drugs on driving performance: acrivastine (8, 16 and 24 mg); the combination of acrivastine (8 mg) with pseudoephedrine (60 mg); terfenadine (60, 120 and 180 mg); diphenhydramine-HCl (50 mg); and placebo. The subjects were 18 healthy female volunteers. Drug effects were assessed in two repetitions of two driving tests (highway driving and car-following) after each treatment. Acrivastine's impairing effects in both driving tests were similarly dose-related. The 8-mg dose had a small, but significant, effect on highway driving in the first trial. The 16-mg and 24-mg doses significantly impaired driving in both tests during the first trial and the 24-mg dose did so again during the second trial. Neither the combination of acrivastine with pseudoephedrine nor terfenadine caused any significant impairment of performance. Diphenhydramine significantly impaired driving in both tests during every trial. In conclusion, the normal therapeutic dose of acrivastine (8 mg) had little effect on driving performance, and virtually none when that dose was given in combination with pseudoephedrine (60 mg). Higher doses of acrivastine severely impaired driving performance. Terfenadine had no significant effect on driving performance after any dose while diphenhydramine strongly impaired every important driving parameter.

Administration, Oral↗