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At least 613 records · Page 34Linked to original sources
PubMed2000

Relation of useful field of view and other screening tests to on-road driving performance.

The purpose of this study was to examine the value of a clinical driving assessment battery in predicting performance on an on-road driving test. 43 participants referred to the Bryn Mawr Rehab Adapted Driving Program for evaluation of driving ability underwent an evaluation consisting of a predriver screening and an on road driving test. The predriver screening included a vision screening, a reaction rime task, a split-attention task, the Hooper Visual Organization Test, verbal and symbolic sign recognition, and assessment of Useful Field of View. Logistic regression analyses were applied to identify which predriver screening variables could be used to predict outcome on the on road driving test (pass/fail); UFOV was that best single predictor. The addition of screening tests beyond UFOV alone did not increase predictive validity. These findings suggest that UFOV may serve as an indicator of the need for further driving assessment.

Age Factors↗
PubMed1987

The use of vignette analysis of dangerous driving situations involving alcohol to differentiate adolescent DWI offenders and high school drivers.

Adolescent drivers are commonly involved in a variety of dangerous driving situations involving alcohol and drug use. Both situational and personality factors contribute to the adolescent DWI phenomenon. Little is known about young drivers' ability to analyze common potentially dangerous alcohol-involved driving situations, or in what respects differing patterns of analysis differentiate adolescent drivers at risk for DWI. Three groups of adolescent drivers (N = 153) completed an analysis of vignettes questionnaire to assess their decision-making skills and attitudes with respect to drinking and driving. The three comparison groups consisted of high school drivers, young DWI offenders, and juvenile offenders without DWI citations. Subjects were demographically similar except for academic performance, employment, family intactness, car ownership, and drug and alcohol use, with DWI offenders and non-DWI offenders showing significant differences in these measures (p less than .001). Situation analysis showed that adolescent DWI offenders more often than controls drink prior to driving (p less than .001), associate alcohol with many social events and dating (p less than .001), become angry when questioned about driving ability (p less than .001), play drinking games (p = .1), drive fast to resolve stress (p = .001), are less likely to recruit parents when faced with driving intoxicated (p less than .001), and a number of other situational characteristics indicating differential risk between groups for DWI. In many cases, other juvenile offenders matched responses of DWI offenders. Important aspects of these findings are discussed in the context of intervention strategies and the use of vignette analysis as one tool to identify high-risk adolescent drivers for DWI.

Adolescent↗
PubMed1995

[Improved transportation for the elderly (II). The desire for and effects of continuing driving among car manufacturing retirees living in Kanagawa Prefecture].

In order to improve the adequacy and safety of the transportation for the elderly people, the effects of and the desire for continuing driving were analyzed. A questionnaire was sent to 500 car manufacturing retirees, male aged 60 years old and more, living in Kawagawa prefecture near Tokyo. Responses were obtained from 296 people (59.6%). Of these 196 were currently licensed and 149 still drove. Three quarters of the respondents drove for daily shopping and more than 50% drove for medical treatment, visiting friends and other purposes. The purposes for driving correlated with each other (p < 0.05; psi test) and 80% drove more than 3 days per week. One motivating factor for driving was to pick up family members or friends (48%) in addition to daily transportation means (93%), while 61% desired to continuing driving while making full use of the safety devices of the cars. Correspondence analysis showed that the role of driving correlated with a desire to utilize automobile safety devices. It is concluded that we should consider the needs of driving for the elderly, their satisfaction in driving or being driven by them, and should plan medical assessment, improvement in the traffic environment and social support, for example, arranging contacts between elderly driver and elderly with limited transportation options.

Aged↗
PubMedDate not supplied

Drinking locations prior to impaired driving among college students: implications for prevention.

Drinking and driving is perhaps the most serious problem associated with heavy drinking among college students in the United States. In this study, the authors examined drinking locations prior to impaired driving in a college student sample. They administered the Impaired Driving Assessment to 91 college students identified as high risk for drinking and driving. Participants reported an average of 7.98 (SD = 7.67) impaired driving episodes during the past 5 weeks. Using a random effects model, the authors found that location was a significant predictor of blood alcohol content (BAC), F(6,89.6) = 3.62, p = 0.0029. After drinking alcohol at a party, students' average estimated BAC prior to driving (geometric M = 0.089) was significantly greater than all other drinking locations (geometric M = 0.033). The findings of this study provide insight into drinking locations prior to impaired driving and can be used by college health practitioners to develop appropriate interventions to reduce the magnitude of this problem.

Adolescent↗
PubMed2000

Evaluation of fitness to drive. The physician's role in assessing elderly or demented patients.

The role of physicians in deciding whether a patient should continue to drive is purely advisory. However, physicians have a moral and, in some states, a legal obligation to report patients who are no longer fit to drive. The most authoritative test to predict safe driving in the elderly is an on-road evaluation conducted by the state driver's licensing authority, which has ultimate responsibility for deciding a patient's fitness to drive. Patients with mild dementia are generally considered safe drivers, although specialized testing, such as an on-road test, may be indicated. Those with moderate dementia can be further evaluated by the on-road test, since psychological testing to distinguish moderate from mild dementia is imprecise. Severe dementia is generally considered a contraindication to driving. When a patient is deemed unfit to drive, the physician can provide counseling and support to help ease the transition away from driving.

Aged↗
PubMed2006

Characterizing impaired driving in adults with attention-deficit/hyperactivity disorder: A controlled study.

OBJECTIVE: We sought to confirm previously documented findings that individuals with attention-deficit/hyperactivity disorder (ADHD) demonstrate impaired driving behavior when compared with controls. METHOD: Subjects were adults with (N = 26) and without (N = 23) DSM-IV ADHD ascertained through clinical referrals to an adult ADHD program and through advertisements in the local media. Driving behavior was assessed using the Manchester Driving Behavior Questionnaire (DBQ) and 10 questions from a driving history questionnaire. Neuropsychological testing and structured interviews were also administered to all subjects. RESULTS: Substantially more ADHD subjects had been in an accident on the highway (35% vs. 9%, p = .03) or had been rear-ended (50% vs. 17%, p = .02) compared with controls. Analysis of the DBQ findings showed that ADHD subjects had significantly higher mean +/- SD scores than control subjects on the total DBQ (34.1 +/- 15.2 vs. 18.0 +/- 8.6, p < .001) and in all 3 subscales of the DBQ: errors (9.3 +/- 5.4 vs. 4.6 +/- 3.5, p < .001), lapses (12.4 +/- 6.2 vs. 6.1 +/- 3.5, p < .001), and violations (12.4 +/- 5.2 vs. 7.4 +/- 4.1, p < .001). Using the score that separated ADHD from control drivers on the DBQ as a cutoff, ADHD drivers at high risk for poor driving outcomes had more severe rates of comorbidity and exhibited more impaired scores on neuropsychological testing. CONCLUSIONS: Our results confirm and extend previous work documenting impaired driving behavior in subjects with ADHD. Results also suggest that ADHD individuals at high risk for poor driving behavior might be distinguishable from other ADHD individuals on DBQ scores, neuropsychological deficits, and patterns of comorbidities.

Accidents, Traffic↗
PubMed1995

The effects of Dynavision rehabilitation on behind-the-wheel driving ability and selected psychomotor abilities of persons after stroke.

OBJECTIVE: Many conventional rehabilitation exercises, such as pencil-and-paper and computer tasks, may not train perceptual and motor skills as applied to a complex, multiskill activity such as driving. The present study examined the usefulness of the Dynavision apparatus for driving-related rehabilitation. The Dynavision was designed to train visual scanning, peripheral visual awareness, visual attention, and visual-motor reaction time across a broad, active visual field. METHOD: Ten persons with a cerebrovascular accident participated in the study. All had failed behind-the-wheel driving assessments. Subjects participated in a 6-week Dynavision training program using exercises designed to impose various motor, perceptual, and cognitive demands. RESULTS: Dynavision training resulted in significantly improved behind-the-wheel driving assessments as compared to expected outcomes. Comparisons between pretests, posttests, and follow-up tests on a number of Dynavision, response, and reaction time variables showed significant improvements and maintenance effects. Dynavision performance, and, to a lesser extent, choice visual reaction and response times, were found to differentiate between persons assessed as safe and unsafe to drive, and between older and younger drivers. Subject self-reports suggested that a variety of training-related improvements had occurred in everyday functioning. CONCLUSION: Dynavision training shows some rehabilitative promise for improving driving and basic psychomotor skills. Future research on the benefits and limitations of this apparatus should use finer laboratory skill measures and more comprehensive tests of driving and daily functioning to assess more thoroughly skill improvements in persons after stroke.

Aged↗
PubMedDate not supplied

Validation of a driving simulator by measuring the visual attention skill of older adult drivers.

OBJECTIVE: The purpose of this study was to validate a laboratory-based driving simulator as an off-road screening tool for older adult drivers by measuring their visual attention skill, and to determine how the visual attention skill changes across time in a 45-minute simulated driving test. METHOD: One hundred and twenty-nine community-dwelling older drivers volunteered to take part in the study. A range of driving scenarios was devised and implemented in a simulator setting to assess the driving skills of the participants. Visual attention skill, an important contributing factor to motor vehicle crashes, was assessed by the participant's reaction times to a sequence of 14 visual stimuli during the primary task of sustained driving. Repeated measures of analysis of variance (ANOVA) were undertaken to determine the effects of age and gender on the visual attention skill. Trend analysis was performed to investigate how repeated exposures to the visual stimulus affected the reaction time. RESULTS: The visual attention skill of older drivers was found to decline with age (F(1,126)) = 42.52, p value = 0.002), whereas the effect of gender was not significant. Participants increased their speed of reaction times for the first half of the testing then slowed down during the second half. CONCLUSION: That visual attention skill declined with age was consistent with the literature, and validated the driving simulator as an effective screening tool for older adult drivers. With rapid advancements in computer technology, the driving simulator will likely play an important role in assisting occupational therapists with off-road assessment of older drivers.

Aged↗
PubMed1991

When should patients with lethal ventricular arrhythmia resume driving? An analysis of state regulations and physician practices.

Most states have specific laws governing whether patients with seizure disorders can drive. To learn whether similar laws exist for patients with lethal ventricular arrhythmias, we surveyed the Departments of Motor Vehicles in all 50 states. In addition, either an arrhythmia specialist (n = 25) or a general cardiologist (n = 25) was chosen randomly from each state and interviewed to study physician awareness of such laws and physician attitudes toward driving by patients with arrhythmias. Forty-two states (84%) have laws restricting driving by patients who have seizures; only 8 states (16%) have specific laws for patients with arrhythmias. No state makes a distinction between driving by patients with arrhythmias who are managed with an implantable cardioverter-defibrillator (ICD) compared with patients who are managed medically. Seventy-four percent of physicians did not know their own state's laws about driving by patients who have ventricular arrhythmias. Cardiologists were more likely to advise no driving restriction for medically treated patients than for ICD-treated patients. Cardiologists were also more likely to advise permanent restriction for patients with ICDs than for patients treated medically. We conclude that greater legal and medical consensus is needed to guide physicians in advising patients with lethal ventricular arrhythmias about driving restrictions.

Arrhythmias, Cardiac↗
PubMed2006

The effects of coffee and napping on nighttime highway driving: a randomized trial.

BACKGROUND: Sleep-related accidents often involve healthy young persons who are driving at night. Coffee and napping restore alertness, but no study has compared their effects on real nighttime driving performances. OBJECTIVE: To test the effects of 125 mL of coffee (half a cup) containing 200 mg of caffeine, placebo (decaffeinated coffee containing 15 mg of caffeine), or a 30-minute nap (at 1:00 a.m.) in a car on nighttime driving performance. DESIGN: Double-blind, randomized, crossover study. SETTING: Sleep laboratory and open highway. PARTICIPANTS: 12 young men (mean age, 21.3 years [SD, 1.8]). MEASUREMENTS: Self-rated fatigue and sleepiness, inappropriate line crossings from video recordings during highway driving, and polysomnographic recordings during the nap and subsequent sleep. INTERVENTION: Participants drove 200 km (125 miles) between 6:00 p.m. and 7:30 p.m. (daytime reference condition) or between 2:00 a.m. and 3:30 a.m. (coffee, decaffeinated coffee, or nap condition). After intervention, participants returned to the laboratory to sleep. RESULTS: Nighttime driving performance was similar to daytime performance (0 to 1 line crossing) for 75% of participants after coffee (0 or 1 line crossing), for 66% after the nap (P = 0.66 vs. coffee), and for only 13% after placebo (P = 0.041 vs. nap; P = 0.014 vs. coffee). The incidence rate ratios for having a line crossing after placebo were 3.7 (95% CI, 1.2 to 11.0; P = 0.001) compared with coffee and 2.9 (CI, 1.7 to 5.1; P = 0.021) compared with nap. A statistically significant interindividual variability was observed in response to sleep deprivation and countermeasures. Sleep latencies and efficiency during sleep after nighttime driving were similar in the 3 conditions. LIMITATIONS: Only 1 dose of coffee and 1 nap duration were tested. Effects may differ in other patient or age groups. CONCLUSIONS: Drinking coffee or napping at night statistically significantly reduces driving impairment without altering subsequent sleep.

Adult↗
PubMed2000

Carisoprodol, meprobamate, and driving impairment.

This paper considers the pharmacology of the centrally acting muscle relaxant carisoprodol, and its metabolite meprobamate, which is also administered as an anxiolytic in its own right. Literature implicating these drugs in impaired driving is also reviewed. A series of 104 incidents in which these drugs were detected in the blood of drivers involved in accidents or arrested for impaired driving was considered, with respect to the analytical toxicology results, patterns of drug use in these subjects, the driving behaviors exhibited, and the symptoms observed in the drivers. Symptomatology and driving impairment were consistent with other CNS depressants, most notably alcohol. Reported driving behaviors included erratic lane travel, weaving, driving slowly, swerving, stopping in traffic, and hitting parked cars and other stationary objects. Drivers on contact by the police displayed poor balance and coordination, horizontal gaze nystagmus, bloodshot eyes, unsteadiness, slurred speech, slow responses, tendency to doze off or fall asleep, difficulty standing, walking or exiting their vehicles, and disorientation. Many of these cases had alcohol or other centrally acting drugs present also, making difficult the attribution of the documented impairment specifically to carisoprodol and meprobamate. In 21 cases, however, no other drugs were detected, and similar symptoms were present. Impairment appeared to be possible at any concentration of these two drugs; however, the most severe driving impairment and most overt symptoms of intoxication were noted when the combined concentration exceeded 10 mg/L, a level still within the normal therapeutic range.

Accidents, Traffic↗
PubMed1963

Medical handicaps to driving. The pysician's dilemma in evaluation.

The physician who examines a patient for impairment to driving must consider the welfare of the community which will be exposed to the patient's driving in addition to the welfare of the patient himself. The medical opinion on physical and mental fitness to drive should be based upon consideration of:1. Extent and nature of driving exposure.2. Relation of organ system involved to medical requirements of the driving task.3. Duration of condition and nature of adaptability.4. Predicted speed of onset of medical crisis.5. Evaluation of the patient and his environment as a totality. An informed medical society traffic safety committee can be of great assistance to the practicing physician and to the Department of Motor Vehicles in evaluating medical hazards in driving in special cases. Most regulations concerning impairment to driving are currently based upon consensus of expert opinion since statistically valid data are not yet available.

Automobile Driver Examination↗
PubMed2003

[The elderly and driving in the canton of Vaud].

Which elderly person may drive and who should decide? These questions translate a frequent doctor's dilemma. Driving is a tremendously complex perceptive, motor, cognitive, and emotional activity. Assessing someone's ability to drive requires investigating these various components. However, a driving test is often needed. Driving limitations and a psychotherapeutic approach may help a patient give up driving, but occasionally forcing them to quit driving may prove unavoidable. Ideally, a preventive approach initiated long before old age might help decrease the frequency of the old driver's dilemma.

Accidents, Traffic↗
PubMed1992

Driving performance and automobile accidents in patients with sleep apnea.

Patients with untreated obstructive sleep apnea have poorer driving performance than patients without sleep apnea. This poor driving has been demonstrated by studies on a wide variety of driving simulators. Patients with sleep apnea show a significant improvement in driving performance after successful treatment of their apnea with nasal CPAP. After treatment with CPAP, their driving performance is similar to control subjects. Several studies show that patients with untreated sleep apnea are poor drivers and have two to three times more auto accidents than other drivers. These studies reveal that almost one quarter of these patients report frequently falling asleep while driving. Patients with severe sleep apnea or those who perform poorly on driving simulators may be at highest risk of auto accidents. Automobile accidents involving patients with sleep apnea may lead to severe injury or death. Patients, individual physicians, and the medical profession have responsibilities to help prevent these accidents. Finally, more study is needed to improve patient care, protect drivers, and formulate a fair and rational policy concerning drivers with sleep apnea.

Accidents, Traffic↗
PubMed2004

Acceptance of and engagement in risky driving behaviors by teenagers.

Data gathered from 1,430 teenage student drivers and 880 teenage traffic violators were used to examine the levels of exposure to risky driving behaviors and perceptions concerning the level of danger of such behaviors. For student drivers, 55% reported exposure to risky driving by being in a car with a driver engaging in such activities as drunk driving, drag racing, and reckless driving. For the traffic violators, 43% had been engaged in one or more of the risky driving behaviors. Teenagers who had been exposed to risky driving practices were more accepting of risky driving behaviors.

Adolescent↗
PubMed1992

Drunken driving and breath alcohol test at the scene of violence in Japan.

Road Traffic Law prescribes that no person shall drive any vehicle under the influence of intoxicating liquor. Actually, determination of "influence of alcohol" is based on the standard set by the Cabinet Order that alcohol level exceeds 0.5 mg/ml of blood or 0.25 mg/l of expiration. In 1988, number of traffic accidents by drunken driving is 4,808 cases. Among the accidents by drunken driving the rate of fatal causes is 12%. During about last ten years, both of accidents and fatal cases by drunken driving have been decreasing in number, on the other hand, charged or cited number of violation involved "driving under the influence of alcohol" has been increasing. This fact indicates that the concept of seriousness of driving after heavy drinking has been diffused over Japanese nation, but there is still a tendency among drivers to consider the effect of alcohol on driving operation to be negligible when light drinking. In a sobriety checkpoint, alcohol field test are carried out on breath to screen out impaired driver. The most common device used in Japan is an alcohol detector tube, in which cerite particles coated with chromate are packed. The scale on the detector tube is marked to show a value that is lower by 20% than the actual value concerning its inaccuracy. In our study on accuracy of the alcohol detector tube using samples containing approximately 0.25 mg/l of alcohol, which is legal critical level of alcohol impairment, coefficients of variation were 1.50 to 5.45% and deviations from the analytical results by gas chromatography were 18.2 to 19.5%.

Accidents, Traffic↗
PubMed1991

Driving and epilepsy. A review and reappraisal.

Driving and epilepsy is a problem that involves physicians as both care providers to patients and consultants to regulatory authorities. Driving restrictions for people with seizure disorders are intended to ensure the public's safety, but such restrictions may unduly harm the welfare of many people with seizures. In the United States, all states now permit some people with epilepsy to drive. In general, only people whose seizures are adequately controlled are licensed to drive. Adequate control has been judged principally by the seizure-free interval, but individual state standards widely vary. There is a trend toward greater liberalization of driving standards for people with seizure disorders, but the appropriateness and application of these standards continue to raise questions, as does the role physicians should have in the licensing process. Our responsibilities to persons with disabilities and advances in our understanding of seizures and the nature of driving risks warrant a reappraisal of the current medical, legal, and social implications of driving and epilepsy.

Accidents, Traffic↗
PubMed1985

Consensus report. Drug concentrations and driving impairment. Consensus Development Panel.

Most drugs that affect the central nervous system have the potential to impair driving ability. For many years, alcohol (ethanol) has been the drug of greatest concern, since it is, by far, the most frequently recognized cause of drug-impaired driving. Yet as more therapeutic agents, such as benzodiazepines, are introduced and widely used, and as social use of unsanctioned drugs such as cannabis (marijuana) increases, attention must be directed toward other drugs. The National Institute on Drug Abuse sponsored a conference on drugs and driving in Durham, NC, in October 1983. The objective was to reach a consensus on several key issues associated with the current state of knowledge about the relationship between body fluid concentrations of drugs and their pharmacologically active metabolites and degree of driving impairment. It was also of interest to ascertain whether a sufficient body of knowledge exists for an expert to form an opinion, which will meet the applicable standards of proof for legal proceedings, that a person's driving ability was impaired based on body fluid concentrations of a drug. The consensus panel, representing the disciplines of clinical pharmacology, analytical and forensic toxicology, law, and forensic medicine agreed on answers to the following questions: Is ethanol a good model for other drugs? What drugs might have a potential for impairing a driver? How is driving impairment measured? What is known about correlations between driving impairment and drug concentrations? Could "per se" concentrations be established for drugs other than alcohol? Can impairment be established from body fluid concentrations?

Alcohol Drinking↗