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PubMedDate not supplied

Driving evaluation practices of clinicians working in the United States and Canada.

OBJECTIVE: To determine off-road and on-road driving evaluation practices of clinicians in the United States and Canada who assess individuals with disabilities for fitness to drive. PARTICIPANTS: Participants were 114 clinician attendees at the 2003 annual Association of Driver Educators for the Disabled with driving assessment experience ranging from 1 month to 25 years. MEASURES: Information was elicited regarding the clinician, clientele, referral practices, and off-road and on-road driving evaluation practices and retraining practices using a self-administered questionnaire. RESULTS: Participants were largely occupational therapists (68%) who worked in 42 different states and provinces. The most prevalent clientele were persons with traumatic brain injury (97%) and stroke (96%). Testing times greater than 60 min were common for both the off-road (61%) and on-road (49%) evaluations. Commonly performed off-road assessments included the Brake Reaction Timer; Trail Making Test, Parts A and B; and the Motor Free Visual Perception Test, used by 73%, 72%, and 66%, respectively; comprehensive computer-based driving evaluation was rare. Sixty-one percent indicated that all clients underwent on-road evaluation regardless of the off-road results. Finally, 78% used a standard driving route, whereas 24% used a scoring system to evaluate on-road driving. CONCLUSION: Driving assessment in Canada and the United States is multidimensional and time-intensive. Although the domains being assessed are similar across clincians, specific off-road and on-road assessment practices vary greatly. The majority use nonstandardized on-road assessments.

Automobile Driver Examination↗
PubMedDate not supplied

Relation of parent-teen agreement on restrictions to teen risky driving over 9 months.

OBJECTIVES: To determine the relations among parent-teen discordance for restrictions on driving conditions, driving rules, and consequences for rule violations at licensure and subsequent risky teen driving. METHODS: Parents and teens completed telephone interviews at 1, 4, and 9 months after teens became licensed. RESULTS: At each time interval, the degree of disagreement with parent restrictions on driving conditions was positively associated with teen risky driving. CONCLUSIONS: These results demonstrate a positive association between parent-teen discordance for driving conditions and teen risky driving. Initial establishment of restrictions and agreement with them may have longer term protective effects against teen driving risk.

Adolescent↗
PubMedDate not supplied

Phone use and crashes while driving: A representative survey of drivers in two Australian states.

OBJECTIVE: To explore the use and effects of using mobile phones while driving. DESIGN: Cross-sectional survey. SETTING: New South Wales and Western Australia, 20 October to 7 November 2003. PARTICIPANTS: 1347 licensed drivers aged 18 to 65 years. Data were weighted to reflect the corresponding driving population in each state. MAIN OUTCOME MEASURES: Mobile phone use while driving (hand-held, hands-free and text messaging); adverse effects of use. RESULTS: While driving, an estimated 57.3% +/- 1.5% of drivers have ever used a mobile phone and 12.4% +/- 1.0% have written text messages. Men, younger drivers and metropolitan residents were more likely to use a phone while driving and to report a higher frequency of use. Enforcement of hand-held phone restrictions was perceived to be low (69.0% +/- 1.5%) and an estimated 39.4% +/- 2.1% of people who phone while driving use a hand-held phone. Half of all drivers (50.1% +/- 1.6%) did not agree with extending the ban to include hands-free phones. Among drivers aged 18-65 years in NSW and WA, an estimated 45 800 +/- 16 466 (0.9% +/- 0.3%) have ever had a crash while using a mobile phone and, in the past year, 146 762 +/- 26 856 (3.0% +/- 0.6%) have had to take evasive action to avoid a crash because of their phone use. CONCLUSIONS: Phone use while driving is prevalent and can result in adverse consequences, including crashes. Despite legislation, a significant proportion of drivers continue to use hand-held mobile phones while driving. Enhanced enforcement is needed.

Accidents, Traffic↗
PubMed2004

[Driving license of patients with epilepsy, management of their oral drugs and suppositories by non-medical professionals, and the role of pediatric neurologists].

In June 2002, the following new driving regulations were enforced in Japan: 1. A person with epilepsy may be granted a driving license after a seizure-free period of two years. 2. A person with simple partial seizures that would not impair driving safety may be granted a driving license if no other seizures that may impair driving safety have occurred over a period of at least one year. 3. A person with seizures occurring only in sleep may be granted a driving license if no seizures have occurred in waking over a period of at least two years. 4. In case that the above requirements are going to be met within 6 months, driving should be prohibited for 6 months. 5. A person with epilepsy is recommended to apply for a license to drive heavy and/or public vehicles only after a seizure-free period of 5 years without medication. The committee for legal problems of the Japan Epilepsy Society proposed a guideline for non-medical teaching or caring professionals to give children with epilepsy antiepileptic medication or to insert suppositories, if needed, at schools or care institutions. The guideline indicated the following preconditions as important: 1. There must be a wish and consent of the patient or his/her family. 2. Drugs or suppositories are usually taken or used at home and regarded as a safe procedure. 3. Attending doctor should provide clear information about the use and risk of the medication or suppository. 4. Privacy of the patient should be protected. Pediatric neurologists are expected to play an important role on these issues.

Anticonvulsants↗
PubMed2005

Which older patients are competent to drive? Approaches to office-based assessment.

OBJECTIVE: To review three proposed approaches to office-based assessment of older drivers and to evaluate recommendations made about dementia and driving. QUALITY OF EVIDENCE: The American Medical Association's (AMA's) Physcian's Guide to Assessing and Counseling Older Drivers gives recommendations for office-based assessment of older patients' medical fitness to drive. Other approaches examined were those outlined in the sixth edition of Determining Medical Fitness to Drive produced by the Canadian Medical Association (CMA) and SAFE DRIVE. Recommendations for dementia and driving from these documents and other sources were reviewed. All evidence was level III. MAIN MESSAGE: The AMA document usefully identified ways to detect drivers at risk and key areas for assessment (vision, cognition, motor function). Recommendations on evaluating these areas require validation. .he CMA guide and SAFE DRIVE were overly broad in their recommendations. How best to detect cognitive impairment that tocld affect driving remains unclear. CONCLUSION: Office-based approaches to identifying older drivers who are either unsafe to drive or require more extensive evaluation need to be validated.

Aged↗
PubMed1992

Drive-up prescription refill service at a large Navy medical facility.

A drive-up prescription refill service at a large naval medical facility is described. A pharmacy drive-up refill service was created to reduce customer congestion, to reduce demand for parking, and to improve customer service. The drive-up program is staffed by a full-time pharmacy technician, a full-time volunteer, and a part-time pharmacy technician who assists during lunches, breaks, and peak hours. Customers must request refills by telephone, and requests are recorded by a pharmacy answering machine. Recorded requests are transcribed, processed, and checked by a pharmacist in the main pharmacy. Refills ready for pickup are transported to the drive-up site twice daily. If a refill is missing, the customer is asked to park, fill out a missing refill form, and pick up the refill at the main pharmacy. Approximately 700 prescription refills are processed and filled daily at the drive-up service. The addition of a drive-up refill service reduced customer visits to the outpatient pharmacy department by about one third and reduced demand for parking by a projected 360-400 parking spaces per day. The error rate for missing refills is less than 0.5%. The only negative consequence of the drive-up service is less interaction between the customer and the pharmacy staff for counseling. A drive-up refill service at a large naval medical facility reduced customer congestion, reduced parking demand, and improved customer service at the outpatient pharmacy department.

Automobile Driving↗
PubMed1991

[Driving capacity of drug addicts].

When deciding whether a person is fit to drive a vehicle whilst he is in a drug-induced delirious state of mind, we take into consideration the actual condition of the person at the time of driving a vehicle. As a rule, the mere presence of drugs in the urine or serum does not give a positive clue as to the ability to drive a vehicle. Here one has to take into consideration the effects of the respective drug consumed has at whole. In cases of chronic drug abuse or drug-dependence as well as dependence on methadone-substitutes we have two possibilities to judge by: Either we follow the guidelines of the report by the Federal Government on "Illness and Driving", in which case drug-dependence excludes driving on the whole or we orientate ourselves here again by the actual performance of the person at the time of driving, in which case many drug users would be declared fit and able to drive. However as far as the legal aspect of it goes, it would be contradictory to the law as regards to drinking and driving. Naturally the law wil decide in the end which of the two methods are legally applicable.

Automobile Driving↗
PubMedDate not supplied

The relative effectiveness of sanctions applied to first-time drunken driving offenders.

We selected for study drivers who were sentenced either to jail or a certified driver intervention program (DIP) in Franklin County, Ohio, in 1987 after their first drunken driving (DUI) conviction. Because each drunken driving charge was assigned to one of a pool of 15 judges with widely varying sentencing patterns, there was no apparent bias in subject allocation to the two treatments. For the jailed (n = 124) and DIP (n = 218) cohorts, we compared the likelihood of subsequent impaired driving, as evidenced by rearrest for a new alcohol-related driving offense or involvement in a car crash after drinking in the 4 years following the study-selected event. After controlling for potentially important covariates, such as gender, age, race, blood alcohol concentration, additional charges filed at the time of arrest, and driving history, we derived logistic regression results indicating that DIP attendees had significantly lower rates of subsequent impaired driving. Drivers who had no prior history of at least one non-DUI alcohol-related offense were significantly more likely to display additional impaired driving when jailed as opposed to those enrolled in a DIP (odds ratio [OR] = 2.53, confidence interval [CI] = 1.44, 4.45), while those with previous alcohol-related offenses may have fared better in jail (OR = .56, CI = .11, 2.76). Drivers younger than 21 years of age were also at elevated risk for repeat offenses (OR = 2.46, CI = 1.13, 5.35). DIPs appear most effective when used for persons who have not had previous alcohol-related crashes or driving offenses.

Accidents, Traffic↗
PubMed1993

[Psychoses and driving fitness--development of criteria for clinical assessment].

The legal foundations for driver fitness evaluation in psychiatric conditions are enumerated in the 1985 "Illness and road traffic" expert opinion of the advisory medical council with the Federal Ministry of Transport. In case of the endogenous psychoses, in-patient episodes will invariably give rise to a call for expert psychiatric appraisement, notwithstanding the fact that reliable and valid criteria, with the exception of a standardized driving sample, continue to be almost non-existent. Carried out between 1989 and 1991 with support from the Federal Employment Institute in the framework of an employment creation project as well as from Bundesanstalt für Strassenwesen, the present study hence had been aimed at correlation-statistical identification of as valid driving ability predictors as possible in post-acute patients with a diagnosis of schizophrenic psychosis (ICD 295.3). The patients' pre-discharge fitness for driving, for one, was assessed using a number of psychological procedures and, for the other, was examined during a 60 minute practical driving sample, involving both city and autobahn driving. Driving behaviour during the practical trial was taken down according to pertinent categories, with subsequent judgment of overall driving performance both by self-ratings and by driving instructor ratings by means of a school grades scale of 1 to 6. With reference to pertinent studies elsewhere, our test battery had consisted of procedures for testing visual perception, reaction, selective and split attention, personality structure, anxiety, and risk-taking.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Driving safety among patients with automatic implantable cardioverter defibrillators.

OBJECTIVE: To determine the driving behavior of patients following the placement of automatic implantable cardioverter defibrillators (AICDs). SUBJECTS AND DESIGN: Forty patients with AICDs (33 men, seven women; mean age, 62.7 years) responded to a questionnaire designed to ascertain driving behavior after hospital discharge. RESULTS: Despite medical advice never to drive again, 28 patients (70%) resumed driving, with the majority doing so by 8 months after AICD implantation. Of these, 11 (40%) identified themselves as the primary driver in their household. Fourteen (50%) drove daily. Two (7%) were driving and continued to drive during discharge of their AICDs. Twenty-five (91%) reported that they felt comfortable and safe while driving. CONCLUSION: A majority of patients with AICDs continue to drive after a proscription of this activity by health care workers.

Automobile Driving↗
PubMed1996

[The syndrome of drive pathology in children and adolescents (the age-related and nosological aspects)].

43 children and adolescents, 27 boys and 16 girls aged 7 to 15, with the drive disorders syndrome were investigated. The diagnosis of schizophrenia was in 30 patients (the first group), residual organic brain damage in 13 (the second group). In the first group an onset of disease coincided with the first age crisis (3-4 years). Among the variants of the drive disorders such disorders as a runaway from home and wandering, that had irresistible and impulsive character were dominant. Near the puberty, the sexual and aggressive-sadistic drives prevailed. The drive disorders were accompanied with effective, neurotic-like and some other psychopathological symptoms. In the second group the first manifestations of the drive disorders coincided with the young school-age (7-9 years) period and these disorders occurred in the prepuberty (10-12 years) more frequently. The drives to the theft, runaway from home and wandering, aggression, increased sexual drive were dominant. The signs of psychic infantilism and immature emotional-will sphere come forward in the patients on this group. It was determined that inherited-constitutional as well as social factors are very significant for formation of the drive disorders syndrome.

Adolescent↗
PubMed1976

Characteristics of driving in relation to the drug and alcohol use of Finnish outpatients.

A questionnaire was administered to 765 rheumatoid arthritic, 715 tubercular and 1,050 psychiatric outpatients and to 587 control subjects concerning their use of drugs and alcohol, driving habits and traffic accident involvement. The driving populations of all groups were matched as to their age and area of residence. The results of the study show a relatively very small number of driving licence holders among rheumatoid and psychiatric patients whereas the tubercular group includes as many driving licences as the control group. Also, the annual driving experience of the rheumatoid arthritic and psychiatric patients was low. The main reason for driving was recreation, and the driving mainly took place on highways. Excluding the psychiatric patients, the patient groups had been involved less often in traffic accidents that the controls. The use of drugs correlated inversely with driving: the more you used drugs the less you drove. Also the consumption of alcohol increased in direct proportion to the number of kilometres driven: the greater the alcohol consumption per drinking session, the more you drove annually and were involved in accidents.

Adolescent↗
PubMed2001

Visual search and urban driving under the influence of marijuana and alcohol.

The purpose of the present study was to assess the effects of low doses of marijuana and alcohol, and their combination, on visual search at intersections and on general driving proficiency in the City Driving Test. Sixteen recreational users of alcohol and marijuana (eight males and eight females) were treated with these substances or placebo according to a balanced, 4-way, cross-over, observer- and subject-blind design. On separate evenings, subjects received weight-calibrated doses of THC, alcohol or placebo in each of the following treatment conditions: alcohol placebo + THC placebo, alcohol + THC placebo, THC 100 &mgr;g/kg + alcohol placebo, THC 100 &mgr;g/kg + alcohol. Alcohol doses administered were sufficient for achieving a blood alcohol concentration (BAC) of about 0.05 g/dl. Initial drinking preceded smoking by one hour. The City Driving Test commenced 15 minutes after smoking and lasted 45 minutes. The test was conducted over a fixed route within the city limits of Maastricht. An eye movement recording system was mounted on each subject's head for providing relative frequency measures of appropriate visual search at intersections. General driving quality was rated by a licensed driving instructor on a shortened version of the Royal Dutch Tourist Association's Driving Proficiency Test. After placebo treatment subjects searched for traffic approaching from side streets on the right in 84% of all cases. Visual search frequency in these subjects did not change when they were treated with alcohol or marijuana alone. However, when treated with the combination of alcohol and marijuana, the frequency of visual search dropped by 3%. Performance as rated on the Driving Proficiency Scale did not differ between treatments. It was concluded that the effects of low doses of THC (100 &mgr;g/kg) and alcohol (BAC < 0.05 g/dl) on higher-level driving skills as measured in the present study are minimal. Copyright 2001 John Wiley & Sons, Ltd.

Journal Article↗
PubMed2002

Estimation of premotor synaptic drives to simulated abducens motoneurons for control of eye position.

The firing rate of an abducens motoneuron (AbMN) is linearly related to eye position with slope K, above recruitment threshold theta. Within the AbMN population K increases as theta increases. It is possible that these properties depend on the synaptic drives generated by the major premotor inputs to AbMNs, namely position-vestibular-pause (PVP) cells and eye and head velocity (EHV) cells in the medial vestibular nucleus, and eye-position and burst-position cells in the nucleus prepositus hypoglossi (NPH). Premotor inputs to AbMNs were therefore modelled by a two-layer net, in which the output nodes represented the AbMNs (with fixed intrinsic properties) and the input nodes the three classes of premotor units ( n=20/class). Conjugate eye-position commands were used to generate the firing rates in premotor units found experimentally. The output of the net was compared with observed AbMN firing rates, and the resultant error used to adjust the magnitude and sign of the connection weights between premotor units and AbMNs. To provide additional constraints on permitted weights, the net was also trained under simulated smooth pursuit, cancellation of the vestibular-ocular reflex, and the vestibulo-ocular reflex itself (all at 0.5 Hz). Since the projections of EHV cells have not been clearly characterized, two versions of the model were trained, corresponding to different assumptions about these projections. In both versions, position-related AbMN firing rates were derived mainly from an excitatory drive from PVP cells and an inhibitory drive from NPH cells with the opposite ON direction. Variation in AbMN threshold theta and position sensitivity K depended on the strength of the drive from the NPH: the stronger the drive, the higher both K and theta. This arrangement was observed in six variants of the basic model with different parameter values, and in a simplified form (constant PVP drive and varying NPH drive) was able to generate qualitatively the observed relationship between K and theta even in the absence of input from EHV cells. It appears to be a robust mechanism for producing the experimentally observed variation in position-related firing of AbMNs, even without a contribution from their intrinsic properties, and predicts that local blocking of the inhibitory drive from cells in the NPH should lower both the position threshold and sensitivity of an individual AbMN. The model also indicates that if EHV cells have ipsilateral inhibitory projections, as has been proposed on the basis of their similarity with cells receiving input from the flocculus, then their role in eye-position control would reinforce that of cells in the NPH.

Abducens Nerve↗
PubMed2006

The influence of pulmonary receptors on respiratory drive in a rabbit model of pulmonary emphysema.

We have observed that pulmonary rapidly adapting receptor activity is greater in emphysematous rats than in controls. Pulmonary receptor activity, if modified by lung disease, may produce an inappropriate drive to breathe which may be perceived as dyspnoea. To investigate the efferent (drive) component of this hypothesis respiratory drive (phrenic nerve activity) was recorded in a rabbit model of emphysema. Drive was measured as slope and peak height of phrenic nerve activity. Slope and peak height were greater in emphysematous rabbits than controls, by 28% and 34%, respectively. Block of slowly adapting pulmonary stretch receptors by inhaled sulphur dioxide (which left only rapidly adapting and C-fibre receptors active) decreased drive in control (slope: 38.89+/-2.29 to 24.09+/-1.26, P<0.01) but not emphysematous rabbits (slope: 49.92+/-4.11 to 54.51+/-5.28, NS). Subsequent vagotomy decreased drive in emphysematous rabbits (slope: 54.51+/-5.28 to 41.41+/-3.90, P<0.05) but not controls (24.09+/-1.26 to 23.07+/-1.84, NS). Increased rapidly adapting receptor activity may, in part, increase respiratory drive in emphysema. This vagal component is only part of the total increased drive which may be perceived as dyspnoea in man.

Adaptation, Physiological↗
PubMed1999

Trends in safe driving behaviors and in relation to trends in health maintenance behaviors in the USA: 1985-1995.

Specific health and safe driving behaviors of the American adult population during the period 1985-1995, were examined for trends and for consistencies in observing them. The data base consisted of the results of annual surveys conducted on representative samples of 1250 people of the US adult population. Two indices were developed: a Health Index (HI) and a Safety Index (SI). The Health Index reflects the level of practice of six health and disease preventing behaviors (in order of decreasing importance: not smoking, frequent exercises, avoiding fat foods, having an annual blood pressure test, avoiding high-cholesterol foods, and having an annual dental exam). The Safety Index reflects the level of practice of three safe driving behaviors (in order of decreasing importance: wearing safety belts, avoiding drinking and driving, and observing the speed limit). Only a weak association was found among the individual safe driving behaviors, among the individual health maintenance behaviors, and between the two sets of behaviors. Over the 11-year study period the change in the Health Index has been practically and statistically insignificant, whereas the change in the Safety Index was both statistically and practically significant. The small improvement in the Safety Index actually masked a complex pattern of changes in safe driving habits. The three component Safety Index behaviors did not change in the same manner over the 11-year period. The greatest and most consistent increase was in the use of safety belts, with the reported percent who use it all the time increasing from 41.5% in 1985 to 74.1% in 1995 (an increase of 80%). There was also a consistent positive trend in refraining from drinking and driving, but the overall improvement was less dramatic than that reported for use of safety belts: from 71.6% reporting they never drink and drive in 1985 to 79.1% in 1995 (an increase of 10%). Still, it is noteworthy that by 1995 nearly 80% of the people reported they never drink and drive. Finally, obeying the speed limit did not improve over the 11-year period.

Accidents, Traffic↗
PubMed2002

Tractor-driving hours and their relation to self-reported low-back and hip symptoms.

Tractor driving might be one causal risk factor in the incidence of low-back and hip symptoms among farmers. Information on the annual exposure to tractor driving and its distribution among different work operations is scarce. The purpose of this study was to quantify the total and the annual time driving tractors among Swedish farmers and its distribution into different work operations, and to investigate the risk of low-back and hip symptoms in relation to tractor driving within different work operations. The data were collected from a questionnaire study sent to all farms with acreage more than 10 ha in a county in Sweden. Farmers having farming and/or forestry as their main occupation in 1995 were included in the analysis. The annual tractor-driving time and the percentage distribution within different work operations were calculated for females, males, the total group and four production groups. The risk calculations for low-back and hip symptoms from the variables related to tractor driving were performed on the total group. The results showed that the mean annual tractor-driving time was 472 h. Ploughing was the single most time-consuming work operation but it had no influence on the risk for low-back or hip pain. The results showed that some of the variables investigated related to tractor driving influenced the risk for low-back and hip symptoms.

Agricultural Workers' Diseases↗
PubMed1998

Methods and clinical significance of studying chemical drives.

Studying chemical control of ventilation implies evaluation of both chemoreceptor functions taken into account however the mechanical factors influencing the effector organs. The role of abnormal chemical drives has been demonstrated in COPD patients. More recently the role of abnormal chemical drives was studied during sleep. Absent or severely depressed drives may facilitate the development of central apneas and hypoventilation. High drives may lead to periodic breathing eventually with central apneas as well. Most intriguing therefore is the role of chemical drives in the pathogenesis of the obstructive and central sleep apnea syndrome. There is accumulating evidence that fluctuations in the drive to breathe may adversely affect the upper airway patency and facilitate upper airway closure and obstructive apneas. Interaction with chemical drives (eg by administration of acetazolamide) has been shown to improve central (and eventually also obstructive) sleep apnea. Studying chemical drives will probably be clinically useful in solving the complex mechanisms controlling ventilation during sleep in patients with and without underlying airway or lung disease.

Acetazolamide↗