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PubMed2005

The impact of supraventricular tachycardias on driving ability in patients referred for radiofrequency catheter ablation.

AIM: The aim of the present study was to evaluate the occurrence of arrhythmia-related symptoms in patients with supraventricular tachycardia (SVT) referred for radiofrequency catheter ablation (RF ablation) with special focus on driving ability. METHODS AND RESULTS: Of the 301 patients referred for RF ablation between November 1998 and December 2000 due to SVT 226 were active drivers. The present study is an interview study with structured questions. Hemodynamic symptoms were frequently encountered during tachycardia. The symptoms occurred irrespective of driving. In the 226 active drivers, fatigue was reported in 77%, dizziness in 47%, breaking into a cold sweat in 52%, near-syncope in 50%, and syncope in 14%. Women experienced all symptoms more frequently than men: fatigue (P < 0.05), dizziness (P < 0.01), cold sweat (P < 0.05), near-syncope (P < 0.001), and syncope (P < 0.01). Fifty-seven percent of the patients had experienced tachycardia while driving, and 42% of those patients had to stop because of it. Twenty-four of all patients considered their tachycardia as an obstacle to driving. There was a significant correlation (P < 0.001) between having experienced near-syncope and considering the risk for tachycardia as an obstacle. CONCLUSIONS: SVT frequently occurs during driving and is often associated with hemodynamic symptoms including near-syncope and syncope. Women reported tachycardia-related hemodynamic symptoms more often than men. There is a correlation between having experienced near-syncope and considering tachycardia as an obstacle to driving. The risk for serious tachycardia-related symptoms should be considered, especially in occupational drivers.

Adult↗
PubMed1990

Drinking, drug use, and driving among rural midwestern youth.

Data concerning self-reported driving after drinking or using other drugs were collected from 3,382 junior and senior high school students in rural central and southern Illinois. Drinking, drug use, and driving increased steadily with age, with 42% of the 12th grade class indicating they had driven a car at least one time in the past six months after drinking or using other drugs. Riding with a driver who had been drinking also increased with age; 20% of the seventh grade sample had ridden in a car with a drinking driver, while 58% of the 12th grade sample reported having done so. Slightly more females had ridden in a car with a driver who had been drinking than males, while males reported higher rates of driving after drinking or using other drugs than females. Correlation analyses indicated 22 variables related significantly to drinking, drug use, and driving. Forward stepwise multiple regression analysis showed that 11 variables related significantly to riding as a passenger with a drinking driver. Thirteen variables were related significantly to driving after drinking or using other drugs. Frequency of alcohol use variables were the most powerful indicators of self-reported driving after drinking or using other drugs in this sample.

Adolescent↗
PubMed2003

Who can drive home from the emergency department? A questionnaire based study of emergency physicians' knowledge of DVLA guidelines.

OBJECTIVE: To determine whether doctors working in emergency departments are aware which of the common conditions seen have driving restrictions associated with them and whether they routinely advise patients of these restrictions. METHODS: 200 questionnaires were distributed to all grades of doctor currently working in 15 emergency departments in Wessex and the south west. The survey was anonymous so follow up of non-responders was not possible. Doctors were asked to indicate which of the 20 commonly seen conditions listed had DVLA guidelines restricting driving activity at least temporarily, and in which of these conditions they actually advised patients appropriately about their driving. In addition the MDU, GMC, and the Department of Transport web site were contacted to establish what they considered to be good medical practice regarding issuing advice about driving. RESULTS: 102 doctors (51%) responded to the survey. Knowledge regarding restrictions for various conditions varied, with 87.5% responding correctly about a first fit to only 7.8% regarding a collapse query cause. With regard to advising patients, 79.4% of doctors responding said that they routinely advised patients about stopping driving after a first fit, 32% advised patients after a single transient ischaemic attack, and only 7% after a collapse query cause. CONCLUSIONS: Doctors working in emergency departments are aware of conditions that lead to an inpatient admission that have driving restrictions. However, knowledge of conditions where patients are likely to be discharged was not as complete and advice was less likely to be given to patients. Emergency department doctors need to be more aware of restrictions that apply to conditions where patients are to be discharged.

Automobile Driving↗
PubMed2006

Parent involvement in novice teen driving: a review of the literature.

Motor vehicle crashes remain elevated among novice teen drivers for at least several years after licensure. Licensing policies and driver education are the two primary countermeasures employed to decrease young driver crash risks. Graduated driver licensing policies have proved to be effective in reducing crash rates where evaluated. Driver education is an essential part of teaching teens the rules of the road and operating a vehicle, but requires few hours of professional driver training, relying mainly on parents to provide most of the supervised practice driving teens obtain before independent driving licensure. The few studies that have been conducted to increase parent supervised practice driving have not shown positive results. Moreover, it is unclear that increases in practice would improve independent driving safety. Recent research has shown that parent management of the early independent driving experience of novice teens improves safety outcomes, and other research has shown that it is possible to increase parent management practices. This paper provides a review of the literature on parent involvement in supervised practice and independent driving, and efforts to increase parental management.

Accidents, Traffic↗
PubMed2004

Traffic ticket fixing and driving behaviours in a large French working population.

STUDY OBJECTIVE: The use of connections who have the authority to cancel penalties related to traffic violations seems to be very frequent in France. This study aimed at describing risk taking driving behaviours associated in France with using connections to have traffic tickets cancelled (ticket fixing). DESIGN: Retrospective study on driving behaviour and road safety conducted between March and December 2001 within a cohort of French employees. SETTING: France. PARTICIPANTS: Employees of the French national utility company who have been followed up since 1989. The sample comprises 10 594 men aged 53-63 years and 3258 women aged 48-63 in 2001. MAIN RESULTS: One third of the men and one fifth of the women reported that they had had a ticket fixed at some time. Those who reported having tickets fixed were more likely than the others to report high driving speeds (adjusted odds ratios (aOR) were 1.24, 1.52, and 1.66 in built up areas, on rural roads, and on motorways respectively), to report driving while under the influence (aOR = 1.39), and to report risky use of cellular phone while driving (aOR = 1.83). In addition, participants who reported having tickets fixed were more likely to have had at least one serious road traffic accident in the past 11 years (aOR = 1.21). CONCLUSIONS: Indulgence and the use of connections are common practices in France. These results suggest that it is to confer a feeling of impunity that jeopardises efforts to combat unsafe driving. Abolition of these traditions is essential to ensure the credibility of preventive and repressive measures.

Accident Prevention↗
PubMed2005

Long driving time is associated with haematological markers of increased cardiovascular risk in taxi drivers.

AIMS: To examine the association between driving time and changes in haematological markers of increased risks for cardiovascular diseases (CVD). METHODS: The authors conducted a cross sectional analysis of baseline data from the Taxi Drivers' Health Study cohort in Taipei, Taiwan. They retrieved information on comorbidity, laboratory tests, age, and anthropometric measures from medical records of 1157 subjects (mean age 44.6 (SD 8.6) years). Whole blood cell (WBC) count was used as the primary haematological marker for increased CVD risk, and platelet count and haematocrit as the secondary markers. Standardised questionnaires were implemented to collect information on demographics, lifestyle, work related physical and psychosocial factors, and driving time profiles. Multiple regression was used to estimate the adjusted effects of driving time on three haematological markers. RESULTS: The mean measured hematological marker was 6656 (SD 1656) cells x10(6)/l for WBC, 47.2 (SD 3.5) % for hematocrit, and 243 (SD 52) cells x10(9)/l for platelets. The driving time was 264 (SD 76) hours/month. Compared with drivers who drove < or =208 hours/month (1st quartile cut off), drivers who drove >208 hours/month had a higher WBC count (by 317 x10(6)/l; 95% CI 99 to 535), haematocrit (by 0.8%; 95% CI 0.3 to 1.2), and platelets (7.9 x10(9)/l; 95% CI 1.0 to 14.8). After adjusting for conventional CVD risk factors (age, sex, smoking, hypertension, diabetes, and hypercholesterolaemia), obesity, alcohol drinking, regular exercise, and sociodemographics (education, marital status, income, and so on), long driving time was still associated with significant increases in WBC and platelets, whereas the effect on haematocrit was diminished and became statistically non-significant. Additional controls for physical workload, self-perceived job stress, and job dissatisfaction did not alter the associations with increased WBC and platelets. CONCLUSIONS: Longitudinal studies are needed to confirm the observed cross sectional association and to further examine the specific occupational exposures accountable for the association between driving time and haematological markers of systemic inflammation and haemostatic alteration.

Adult↗
PubMedDate not supplied

A single-photon emission computed tomography imaging study of driving impairment in patients with Alzheimer's disease.

Single-photon emission computed tomography (SPECT) was used in this study to examine the neurophysiologic basis of driving impairment in 79 subjects with dementia. Driving impairment, as measured by caregiver ratings, was significantly related to regional reduction of right hemisphere cortical perfusion on SPECT, particularly in the temporo-occipital area. With increased severity of driving impairment, frontal cortical perfusion was also reduced. Clock drawing was more significantly related to driving impairment than the Mini-Mental State Examination (MMSE). Driving impairment in Alzheimer's disease is related to changes in cortical function which vary according to the severity of the disease. Cognitive tests of visuoperceptual and executive functions may be more useful screening tools for identifying those at greatest risk for driving problems than examinations like the MMSE that are weighted toward left-hemisphere-based verbal tasks.

Activities of Daily Living↗
PubMedDate not supplied

Glare disability and driving safety.

PURPOSE: Increasing investigation of the visual elements of safe driving environments may be of great benefit to society. Visual disability appears to be only one of many visual factors related to traffic accidents. The purpose of this article was to examine the type of visual impairment mediated by the increased glare sensitivity in adult drivers using the original halometer glare test. METHODS: In this article, the visual sensory, cognitive and motor functions relevant to driving, their measurement, the epidemiology and prevention of age-associated functional impairments and the relationship of functional impairments to both self-reported driving and the imposition of legal restrictions are reviewed. RESULTS: The problem of night and tunnel driving is the most urgent in relation to the effects of glare from vehicle headlights on motion perception of drivers. The reduced mesopic vision and increased sensitivity to glare are accompanied by an increased risk of nighttime accidents. Elderly drivers and patients with beginning cataract cannot sufficiently fulfill the criteria for night driving ability because of contrast and glare sensitivity. It is indispensable for the parameters mentioned to be carefully measured and for drivers to be informed that night driving ability may be impaired, even if visual acuity is sufficient. CONCLUSIONS: It would be advisable for traffic safety if simple tests for contrast and glare sensitivity were implemented for vehicles and/or were regularly added to the requirements for a driver's licence, at least for older drivers. The age, functional status and test result limits should be defined to avoid a risk factor in traffic.

Accidents, Traffic↗
PubMed1992

Dementia and driving.

Many European countries test cars, but not their drivers, as they age. There is evidence to suggest that human factors are more important than vehicular factors as causes of motor crashes. The elderly also are involved in more accidents per distance travelled than middle-aged drivers. As the UK relies on self-certification of health by drivers over the age of 70 years, we examined the driving practices of patients with dementia attending a Memory Clinic. Nearly one-fifth of 329 patients with documented dementia continued to drive after the onset of dementia, and impaired driving ability was noted in two-thirds of these. Their families experienced great difficulty in persuading patients to stop driving, and had to invoke outside help in many cases. Neuropsychological tests did not help to identify those who drove badly while activity of daily living scores were related to driving ability. These findings suggest that many patients with dementia drive in an unsafe fashion after the onset of the illness. The present system of self-certification of health by the elderly for driver-licensing purposes needs to be reassessed.

Accidents, Traffic↗
PubMed2007

Development of the Adelaide driving self-efficacy scale.

OBJECTIVE: To describe the development of the Adelaide Driving Self-Efficacy Scale (ADSES) and to report on its reliability and validity. METHODS: A set of 12 driving behaviours, developed through literature review, clinical experience and expert review, were rated for self-efficacy using a Likert scale. Internal consistency was investigated using a Cronbach's alpha coefficient and construct validity by comparing ADSES scores of stroke and non-stroke drivers. Criterion-related validity was examined by comparing ADSES scores with the result on a standardized on-road assessment. SETTING: A rehabilitation hospital in Adelaide, South Australia. PARTICIPANTS: Staff from the hospital and stroke patients from the rehabilitation unit. Data from a non-stroke sample (n -/ 79) and stroke patients (n -/ 81) were used to test internal consistency and construct validity. A separate group of 45 people recommended for a driving assessment, of whom 34 were stroke patients, were used to test criterion validity. RESULTS: Cronbach's alpha coefficient was 0.98, indicating high internal consistency. The non-stroke and stroke groups showed significant differences in ADSES scores (t(158)-/ 5.5, P B < 0.05), demonstrating construct validity. Differences in ADSES scores for those participants who passed or failed the on-road assessment were significant for both the entire driving assessment group (t(43)-/ 3.2, P B < 0.05) and the stroke subgroup (t(43)-/ 3.2, P B < 0.05), indicating criterion validity. CONCLUSION: The ADSES has demonstrated internal consistency and construct validity with the stroke and non-stroke population. The scale demonstrated criterion validity in its relationship with outcome of an on-road driving assessment. It appears to be a reliable and valid measure of driving self-efficacy.

Adult↗
PubMed2003

Does graduated licensing empower parents to place greater restrictions on their newly licensed teens' driving?

This investigation sought to determine if Maryland's new graduated licensing program was associated with greater levels of parental involvement in, and restriction on, teens' unsupervised driving. Separate samples of teens with provisional licenses were interviewed by telephone before (n = 424) and after (n = 600) the new program took effect. The findings indicated that teens in the new program reported significant increases in the frequency of parental driving instruction and supervised driving duringthe permit phase. There were no differences in amounts of instruction or supervised driving after provisional licensure. Also, teens in the new program reported greater overall amounts of parental restriction on their driving; however, few specific restrictions showed increases. Programs that encourage parents to regulate, restrict, monitor, and supervise the driving privileges of their teens during their provisional period of licensure are recommended. Graduated licensing laws and programs benefit from specific behavioral interventions targeted to, and implemented by, parents.

Accidents, Traffic↗
PubMed1989

The epidemiology of drinking and driving: results from the Behavioral Risk Factor Surveillance System, 1986. Behavioral Risk Factor Surveillance Group.

Alcohol-related motor vehicle crashes result in thousands of deaths and serious injuries each year. For effective intervention in this problem, it is important to understand the epidemiology of "drinking and driving." To study this behavior, we analyzed the self-reports of 34,395 respondents in the 26 states conducting behavioral risk factor surveillance during 1986. An estimated 4.1% of the survey population and 7.2% of drinkers reported drinking and driving at least once in the month before the survey. In general, the prevalence of drinking and driving was highest among men, young adults, and divorced or separated persons. States with the highest prevalence of drinking and driving tended to cluster in the north-central region of the United States. In 15 states conducting surveillance from 1984 to 1986, the overall prevalence of drinking and driving changed little during this period. However, among persons less than 25-years old, the prevalence decreased. Efforts to deter drinking and driving are likely to reduce the number of motor vehicle crashes and should include both legal sanctions and greater public education about the dangers of this behavior.

Adolescent↗
PubMed1989

An attribution theory perspective on alcohol-impaired driving.

Attribution theory is offered as a theoretical framework for generating and testing hypotheses about how people perceive and respond to the behavior of impaired driving. Recent work on the attribution of responsibility for alcohol-impaired driving indicates that the perceived seriousness of this behavior varies with the consequences and circumstances associated with it. In some instances, impaired driving is not considered to be particularly blameworthy, while in other instances, relatively minor variations in the event sequence have pronounced effects on the assignment of responsibility and punishment. In general, the seriousness of impaired driving is related to the consequences produced. Impaired driving is not perceived as being particularly negligent as long as it does not result in harm to others. Other findings suggest that people are likely to deny the personal relevancy of situations involving impaired driving. The final section of the article discusses the program implications of this research. Specific attention is given to sources of attributional "error" and to how these inaccuracies might be identified and corrected within a prevention/intervention program context.

Alcohol Drinking↗
PubMed2006

Driving experiences of disabled drivers.

OBJECTIVE: To study the influence of non-standard controls on return to driving after disability, including prevalence of accidents/retraining difficulties. DESIGN: Postal questionnaires sent within two years of assessment to 972 disabled drivers seen over a three-year period. SETTING: Scottish Driving Assessment Service. SUBJECTS: All patients considered capable of driving after assessment during the study period. RESULTS: Five hundred and eighty-nine people (61 %) replied who were representative of the total population (mean age 55 years, range 19-87); 73% were male and 70% were disabled for up to two years. Overall 79% respondents had returned to driving (highest reported success with standard manual car (86%) and lowest using left foot to accelerate and brake (66%) (chi2 = 16.6, P = 0.005)). A significantly higher proportion of the 30 patients (6.5%) admitting to accidents and 25 (5.4%) to problems with retraining were using non-standard driving techniques, especially the use of hand controls. CONCLUSION: Disabled drivers returning to drive using non-familiar controls had lower success and a higher proportion of accidents and/or problems with retraining than people using conventional controls. If confirmed in larger studies this may have implications for policy-makers as well as specialist practitioners.

Accidents, Traffic↗
PubMed1976

Primitive drive-dominated thinking: relationship to acute schizophrenia and sociopathy.

To investigate primitive drive-dominated thinking in schizophrenic disorders and sociopathic behavior, responses on the Rorschach and other personality tests of 171 acute psychiatric patients were assessed using Holt's system. Results suggested that: (a) Acute schizophrenics were high on primitive drive content, but this was also characteristic of some nonschizophrenics, and other types of disturbed thinking were even more prominent in schizophrenics. (b) There were no significant differences between process and reactive schizophrenics in expression of primitive drive content. (c) Males showed more drive-dominated thinking than females (p less than .10), although sex was not a powerful variable. (d) Depressives showed less drived-dominated thinking than nondepressive (p less than .05). (e) Patients high on sociopathic or rule-breaking behavior tended to show more primitive drive-dominated thinking (p less than .01).

Acute Disease↗
PubMed2006

Driving with distraction in Parkinson disease.

OBJECTIVE: To assess the effects of auditory-verbal distraction on driving performance in Parkinson disease (PD). METHODS: We tested licensed, currently active drivers with mild-to-moderate PD (n = 71) and elderly controls with no neurologic disease (n = 147) on a battery of cognitive, visual, and motor tests. While they drove on a four-lane interstate freeway in an instrumented vehicle, we determined at-fault safety errors and vehicle control measures during a distracter task (Paced Auditory Serial Addition Task [PASAT]) and on an uneventful baseline segment. RESULTS: Compared with controls, drivers with PD committed more errors during both baseline and distraction, and drove slower with higher speed variability during distraction. Although the average effect of distraction on driving performance compared with baseline was not different between the groups, the drivers with PD showed a more heterogeneous response to distraction (p < 0.001): the error count increased in 28.2% of drivers with PD (vs 15.8% in controls), decreased in 16.9% (vs 3.4%), and remained stable in 54.9% (vs 80.8%). The odds of increase in safety errors due to distraction was higher in the PD group even after adjusting for baseline errors, level of engagement in PASAT, sex, and education (odds ratio [95% CI] = 2.62 [1.19 to 5.74], p = 0.016). Decreased performance on tests of cognitive flexibility, verbal memory, postural control, and increased daytime sleepiness predicted worsening of driving performance due to distraction within the PD group. CONCLUSION: The quantitative effect of an auditory-verbal distracter task on driving performance was not significantly different between Parkinson disease (PD) and control groups. However, a significantly larger subset of drivers with PD had worsening of their driving safety errors during distraction. Measures of cognition, motor function, and sleepiness predicted effects of distraction on driving performance within the PD group.

Accidents, Traffic↗
PubMed2003

The influence of age and gender on the driving patterns of older adults.

The purpose of this study was to investigate the influences of age and gender on the driving patterns of 300 older adults. Odds of driving less than every day increased significantly with age and female gender. However, no differences were found in the reduction of overall driving. Females were more likely than men to have stopped or reduced driving under certain adverse conditions and for elective purposes. The driving patterns of today's cohort of older females suggest that the gender gap may be narrowing. Social and cultural issues such as security, safety, and identity with driving may explain existing gender differences.

Age Factors↗
PubMed1995

Relative effects of age and compromised vision on driving performance.

The aim of this study was to determine the relative effects of age and compromised vision on driving-related skills and on-road accidents. A total of 107 subjects were tested. They represented four groups that varied in age and visual status, as follows: (1) a younger, normally sighted group; (2) an older, normally sighted group; (3) a younger, visually compromised group; and (4) an older, visually compromised group. Driving performance was assessed by self-reported and state-recorded accident frequency and by an evaluation of performance on an interactive driving simulator. The older groups had poorer driving-related skills, as measured with our interactive driving simulator, than had the younger groups, but they did not have significantly higher on-road accident rates than the younger groups. The older subjects and those with compromised vision had reduced risk-taking scores, as measured with a self-report questionnaire. In addition, all older drivers had increased eye movements and had slower simulator driving speeds, which suggests that behavioral compensation is made for visuocognitive/motor deficits. Regression analyses showed that compromised vision and visual field loss predicted real-world accidents in our study population.

Accidents, Traffic↗