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PubMed1994

Legal and ethical aspects of driving and working in patients with an implantable cardioverter defibrillator.

Automobile driving is essential to work and leisure for many people, and patients with implantable cardioverter defibrillators (ICDs) are no exception. Whether patients who may suffer sudden incapacitation should be allowed to drive raises important ethical and legal issues. The opinion of physicians regarding when or if it is safe to drive with an ICD varies, and most countries have no regulations to assist such decisions. Such regulations can best be developed by actuarial analysis of the risks involved, although the limited volume of published data on the ICD hinders this process. A policy based on very low levels of social risk from driving by patients with ICDs or a comparison with epileptic patients suggests a ban on driving for 12 to 24 months after ICD implantation. Patients who have received therapy from the ICD within this period would not be granted a driver's licence. As further data from actuarial studies become available, these guidelines could be relaxed for patients at low risk of therapy delivery.

Actuarial Analysis↗
PubMedDate not supplied

Alcohol, personality traits, and high risk driving: a comparison of young, drinking driver groups.

Four types of drinking driver groups were compared with each other and also with two nondrinking driver groups on sensation seeking, social responsibility, and hostility. Groups were also compared on traffic violations, accidents, alcohol consumption, frequency of driving after drinking, frequency of driving impaired, and perception of driving risk taking after drinking. Drivers under the influence apprehended in conjunction with an accident or moving violation had significantly greater alcohol consumption, frequency of driving after drinking, frequency of driving impaired, traffic violations, accidents, and self rating of risk taking after drinking in comparison with other groups.

Adolescent↗
PubMed1990

Screening for drug use among Norwegian drivers suspected of driving under influence of alcohol or drugs.

Two hundred and seventy blood samples selected at random from Norwegian drivers apprehended on the suspicion of drunken or drugged driving were screened for the presence of amphetamine, benzodiazepines, cannabinoids, tetrahydrocannabinol (THC) and cocaine. Of the samples tested, 223 were from drivers suspected of driving under the influence of alcohol only (A-cases). In the rest (n = 47) of the cases, the police also suspected drugs as a possible reason for driving impairment (D-cases). In the A-cases, benzodiazepines were found in 17%, cannabinoids in 26%, THC in 13% and amphetamine in 2% of the blood samples. One or more drugs besides ethanol were found in 38% of the A-samples. In the D-cases, benzodiazepines were found in 53%, cannabinoids in 43%, THC in 43%, amphetamine in 13% and 77% of these samples contained one or more drugs. Cocaine was not detected in any sample. Blood alcohol concentrations (BAC) above the legal limit of 0.05% were found in 80% of the drug positive A-cases and in 28% of the drug positive D-cases. The frequency of drug detection in A-samples was similar (40%) in samples with BAC above and below 0.05%, while this frequency was much higher (above 90%) in D-samples with BAC below 0.05% than in D-samples with BAC above 0.05% (53%). Benzodiazepines were most frequently found among drivers above 25 years of age, while cannabinoids were most frequently found among drivers below 35 years. For about 15-20% of the A-cases with BAC below 0.05%, other drugs were detected at concentrations which may cause driving impairment. It was concluded that analysis of alcohol only might often be insufficient in A-cases to reveal driving impairment.

Adolescent↗
PubMed2004

Influences during adolescence on perceptions and behaviour related to alcohol use and unsafe driving as young adults.

OBJECTIVE: To investigate whether aggression, parent and peer influences, and previous traffic-related experiences at ages 15 and 18 impacted on (a) differences between the perceived safe and estimated legal alcohol consumption limit, and (b) driving while impaired (DWI) behaviour at age 21. METHOD: The study population was a birth cohort involved in a longitudinal investigation of health and development. At the ages of 15 and 18, study members completed questionnaires assessing parent and peer attachment, experience travelling with an alcohol impaired adult or youth, aggression, and previous crash experience. At age 21, study members were questioned about how much alcohol they perceived they could drink and still drive safely, and whether they had driven after 'perhaps consuming too much alcohol'. For each participant their legal alcohol consumption limit was estimated using their height and weight. Path analysis was used to determine whether variables measured at ages 15 and 18 predicted differences between the perceived safe and estimated legal alcohol consumption limit and driving while impaired, both measured at age 21. RESULTS: Insufficient females drove while impaired at age 21, who also had complete data on all other variables, to conduct path analysis for this outcome. For males, aggression at ages 15 and 18, travelling with an impaired youth at age 18, and previous crash experience at age 18 predicted DWI behaviour at age 21. Only aggression at age 15 predicted the difference between perceived safe and estimated legal alcohol consumption limit for the males. For females, aggression at ages 15 and 18, and travelling with an impaired adult at age 15 predicted the difference between perceived safe and estimated legal alcohol consumption limit. CONCLUSION: The results show that aggressive behaviours and adult and/or youth modelling of drink driving behaviours in mid- to late-adolescence are related to differences between perceived safe and estimated legal alcohol consumption limit for both genders and driving while impaired for males.

Adolescent↗
PubMed2004

Investigation of the driving experience of a sample of Victorian learner drivers.

This paper presents the results of an investigation of the driving experience of a small sample of learner drivers in Victoria, Australia. Participants (n = 110) kept a continuous logbook of their driving experience over the 2 years of the learner-driver period, including information about the distance and time of each driving trip, their level of confidence, and monthly data concerning the number of crashes, near misses, and unpleasant emotional interactions with their supervising driver. The analysis of these data suggests that learner drivers accrue relatively little driving experience and that they tend to obtain this experience in daytime, fair-weather driving. The implications of these results are discussed.

Adolescent↗
PubMed2004

Identifying predictors of persistent non-alcohol or drug-related risky driving behaviours among a cohort of young adults.

This study sought to identify adolescent risk factors that predicted persistent risky driving behaviours among young adults. It was part of a longitudinal study of a birth cohort (474 males and 459 females). The potential predictors were self-reported data obtained at ages 15, 18, 21 years (academic qualifications, personality, mental health, anti-social behaviour and driving behaviour). The risky driving behaviour outcomes were obtained at ages 21 and 26 years and included driving fast for thrills, taking deliberate risks for fun, excessive speed, dangerous overtaking, and close following (tailgating). Persistent risky drivers were defined as those who often, or fairly often engaged in a behaviour at both ages. A minority of males and very few females were classified as persistent risky drivers. Among the males, the factors that predicted at least one, or more of the outcomes were the personality trait of low constraint (i.e. low scores for control, harm avoidance, and traditionalism), aggressive behaviour, and cannabis dependence. These are characteristics to be borne in mind when developing programmes for young drivers that aim to deter the development of persistent risky driving behaviour.

Accidents, Traffic↗
PubMed2005

Parent-imposed limits on high-risk adolescent driving: are they stricter with graduated driver licensing?

The purpose of this study was to determine whether parent-imposed limits on 16-year-old high-risk driving are stricter in Maryland (MD), a state with graduated driver licensing (GDL) than in Connecticut (CT), a non-GDL state. In both states, parents and adolescents completed telephone surveys about the restrictions that parents placed on their adolescents' driving at night, with adolescent passengers, and at high speeds. In Maryland, surveys took place 1 month (294 parent-adolescent pairs) and 4 months (292 parent-adolescent pairs) after provisional licensure. In Connecticut, surveys took place the first month (132 pairs) and the third month (108 pairs) after adolescent licensure. The findings indicated that after controlling for demographic characteristics, Maryland parents and adolescents reported stricter parent-imposed limits for adolescent passengers, high-speed roads, weekend night driving, and overall limits. Parents in GDL states appear better able to establish and enforce adolescent driving restrictions when the licensing state stipulates, favors, and supports regulated adolescent driving.

Adolescent↗
PubMed2005

Mobile phone use-effects of handheld and handsfree phones on driving performance.

The study was concerned with effects of handsfree and handheld mobile phone dialling and conversation in simulated driving. In the main experiment dealing with conversation, 48 participants drove a distance of about 70 km on a route which led through urban and rural environments. In the dialling experiment, the participants drove a distance of 15 km on a rural two-lane road. The experimental design was mixed with phone mode as a between-subjects factor and phone use (yes/no) as a within-subjects factor. Performance on a peripheral detection task (PDT) while driving was impaired by dialling and conversation for both phone modes, interpreted as an increase in mental workload. Driving performance was impaired by dialling--lateral position deviation increased in a similar way for both phone modes. Conversation had, however, opposite effects--lateral position deviation decreased in a similar way for both phone modes. Driving speed decreased as an effect of dialling with the greatest effect for handsfree phone mode. Conversation also caused reduced speed, but only for handheld phone mode. The effects on speed can be interpreted as a compensatory effort for the increased mental workload. In spite of the compensatory behaviour, mental workload was still markedly increased by phone use. Subjective effects of dialling and conversation were also analysed. Most participants reported a speed decrease but no effect on lateral position deviation as an effect of dialling or conversation. In the conversation experiment, driving performance was rated better for handsfree than for handheld mode. In the dialling experiment, no difference between the two phone modes appeared.

Adult↗
PubMed2005

Driver's exposure to distractions in their natural driving environment.

Unobtrusive video camera units were installed in the vehicles of 70 volunteer drivers over 1-week time periods to study drivers' exposure to distractions. The video data were coded based on a detailed taxonomy of driver distractions along with important contextual variables and driving performance measures. Results show distractions to be a common component of everyday driving. In terms of overall event durations, the most common distractions were eating and drinking (including preparations to eat or drink), distractions inside the vehicle (reaching or looking for an object, manipulating vehicle controls, etc.), and distractions outside the vehicle (often unidentified). Distractions were frequently associated with decreased driving performance, as measured by higher levels of no hands on the steering wheel, eyes directed inside rather than outside the vehicle, and lane wanderings or encroachments. Naturalistic driving studies can provide a useful supplement to more controlled laboratory and field studies to further our understanding of the effects of all types of distractions on driving safety.

Adolescent↗
PubMed2005

Driver's views and behaviors about safety in China--what do they NOT know about driving?

Driving safety has become an extremely severe problem in China due to rapid motorization. Unless more effective measures are taken, the fatality risk and the total fatalities due to road traffic accidents are expected to continue to increase. Therefore, focus group discussions were conducted to explore driver attitudes and safe driver characteristics. The results were then compared with a similar study conducted with US drivers. Although similarities were found, differences were of more importance. The Chinese drivers concentrate more on driving skills and capabilities, whereas the US drivers concentrate more on practical safe driving guidelines. Then direct field observations were conducted for the Chinese drivers to empirically investigate the issues discovered. The use of safety belts, running lights, headlights, and turn signals were observed to investigate the drivers' behaviors. Results show that the safety belt use ratio is about 64%, running light use is nearly zero during rainy and snowy weather, headlights use after sunset is substantially delayed, and only about 40% of drivers use turn signals to indicate their intention to change lanes. These findings indicate that the authorities need to take appropriate countermeasures to change the views of the Chinese drivers regarding driving safety and their unsafe driving behaviors. Improvement of training content and methods as well as police enforcement would be recommended.

Accidents, Traffic↗
PubMed2005

Driver distraction: the effects of concurrent in-vehicle tasks, road environment complexity and age on driving performance.

This paper presents the findings of a simulator study that examined the effects of distraction upon driving performance for drivers in three age groups. There were two in-vehicle distracter tasks: operating the vehicle entertainment system and conducting a simulated hands-free mobile phone conversation. The effect of visual clutter was examined by requiring participants to drive in simple and complex road environments. Overall measures of driving performance were collected, together with responses to roadway hazards and subjective measures of driver perceived workload. The two in-vehicle distraction tasks degraded overall driving performance, degraded responses to hazards and increased subjective workload. The performance decrements that occurred as a result of in-vehicle distraction were observed in both the simple and complex highway environments and for drivers in different age groups. One key difference was that older drivers traveled at lower mean speeds in the complex highway environment compared with younger drivers. The conclusions of the research are that both in-vehicle tasks impaired several aspects of driving performance, with the entertainment system distracter having the greatest negative impact on performance, and that these findings were relatively stable across different driver age groups and different environmental complexities.

Accidents, Traffic↗
PubMed2006

Practicing in relation to the outcome of the driving test.

In Sweden, a written and a driving test must be passed for licensure, and these two examinations are the only means of verifying that learner drivers have acquired the competencies stipulated in the national curriculum. The present study investigated 18-24-year olds regarding the effects of personal background and mode of driver education instruction on the outcome of the driving test. This was done by analysing the following for individual subjects: data on practicing obtained using a questionnaire, and test results of license tests. The results suggest that among the candidates under study, there are equal opportunities in the context of obtaining a driver's license independent of a person's background. The rate of passing was higher for those who started behind-the-wheel training at 16 and applied to take the driving test via a driving school, than for those who started the training at an older age and applied to take the test in person. It was also found that the probability of passing the test was greater if there is successful cooperation between learner and driving school instructor, and if a large proportion of the training been devoted to the task speed adaptation.

Adolescent↗
PubMed2006

Mobile phone use while driving in a sample of Spanish university workers.

A number of epidemiological studies have reported drivers who use a mobile phone while driving have an elevated risk of being involved in a crash. This is particularly concerning as a survey of drivers in the Spanish region of Catalunya found that approximately 87% own mobile phones. The present study investigated the reported frequency of mobile phone use on Spanish roads (for talking and using SMS), the characteristics of the drivers who use mobile phones while driving and whether they altered their driving behaviour when using a mobile phone. The research found that more than 60% use a mobile phone while driving and that the phone is mostly used for making calls, rather than using SMS. In general, males and females use mobile phones about the same reported frequency, although males were more likely to use a mobile phone to talk on the highway. The pattern for age was the same for both male and female participants, with the younger drivers using SMS more frequently than older drivers. On urban roads almost half of the drivers reported changing their driving behaviour when using a mobile phone, while on the highway this figure was slightly over 41%. The reported frequency of using a mobile phone to talk on urban roads was significantly correlated with crash involvement. However, this affect disappeared once the contributions of the demographic and descriptive variables had been partialled out.

Accidents, Traffic↗
PubMed2004

Effects of oxygen concentrations on driver fatigue during simulated driving.

Driver fatigue has been the cause of traffic accidents. Despite this, the amount of time that drivers spend within cars has been increasing due to complex city life, traffic congestion, and particular occupational requirements. Consequently, fatigue and stress cannot be avoided. In present study, in order to find out the possibility for reducing fatigue while driving due to the supply of oxygen, driver fatigue resulting from the passage of time when different oxygen concentrations are supplied has been examined through subjective evaluations and reaction times using driving simulator for 10 male subjects. The results revealed the subjective fatigue feeling was highest in the low rate (18%) oxygen condition, while in the high rate (30%), it decreased to a certain extent. The feeling of sleepiness also showed the tendency to decrease somewhat in the case of the driving time having passed over 1h in the high-rate conditions. Also, the reaction time for braking after being instructed to suddenly stop following more than 2h of driving was reduced in the high-rate oxygen conditions compared to the low-rate oxygen condition. From the above results, it was shown that while driving a car, if the oxygen rate is lowered, fatigue is felt severely, and that in the case of supplying a high-rate of oxygen, the feeling of fatigue is lowered to some extent and the reaction time is shortened. It was suggested that the driver's fatigue can be reduced according to the supply of oxygen.

Accidents, Traffic↗
PubMed2006

Driving pedal reaction times after right transtibial amputations.

OBJECTIVES: To determine if right transtibial amputees have the potential to safely operate the foot pedals of a vehicle with their prosthetic foot, and to determine which of 4 driving techniques is associated with the fastest reaction times. DESIGN: Repeated measures. SETTING: Outpatient amputee clinic. PARTICIPANTS: Ten subjects with right-sided, transtibial amputations. INTERVENTION: Brake pedal response times were measured using 4 different driving techniques: right-sided accelerator with (1) prosthesis operating both the accelerator and brake pedals, (2) prosthesis operating the accelerator and left foot operating the brake, (3) left foot operating both the accelerator and brake, and (4) left-sided accelerator with the left foot operating both the accelerator and brake. MAIN OUTCOME MEASURES: Reaction time, movement time, total response time, and pedal configuration preference. RESULTS: Total response times were slowest using a 2-footed driving technique (P<.001). Total response times were comparable using a left-sided accelerator versus the prosthesis. Using the left foot to operate both the accelerator and brake in a conventional right-footed accelerator design led to the fastest reaction (P<.001) and total response times (P<.01), although it is unclear if this is a realistic driving technique for all amputees. CONCLUSIONS: Our results suggest that right transtibial amputees should be instructed not to drive with a 2-footed technique, and that they have similar pedal response times using their prosthesis when compared with a left-sided accelerator.

Adult↗
PubMed2005

Opioid medication and driving ability.

In many European countries the use of opioids for long-term treatment of nonmalignant pain has dramatically increased during the last decade in order to improve the patient's quality of life, to allow an active social life and the return to work. In modern society, driving is regarded as an essential activity of daily living. Since opioids are centrally acting drugs that may interfere with the ability of safely driving a motor vehicle, the question arises of whether or not and on which conditions patients under continuous opioid medication may be considered fit to drive. In this article the evidence from recent studies of opioid effects on driving ability of patients is reviewed. Based on these data, the prerequisites and restrictions for driving under chronic opioid medication are outlined and practical guidelines are proposed.

Analgesics, Opioid↗
PubMedDate not supplied

Imposed versus involved: different strategies to effect driving cessation in cognitively impaired older adults.

In the lives of persons with cognitive impairments, a time comes when it is necessary to give up driving. This may be a particularly difficult issue for the driver, his or her family members, and their health care professionals. In this study, the phenomenon of unsafe driving by cognitively impaired older adults and the process of affecting driving cessation, was explored through guided interviews with 216 persons throughout the state of Florida. Participants included professionals working in the aging network, mobility counselors, safety officers, individuals with a mild degree of cognitive impairment and their family members. The strategies employed to influence or effect cessation could be categorized as those that involved the individual affected and those that were imposed on the individual. Conditions that appeared to influence whether driving cessation would occur were observed. There were distinct pros and cons to each strategy. In this article, specific information is provided to guide nurses working with cognitively impaired people who have become unsafe drivers. It is expected that driving cessation can be voluntarily effected in many cases but may have to be imposed in others. The skilled nurse will know when and which type of recommendation is appropriate.

Accidents, Traffic↗
PubMed2004

Driving whilst plastered: is it safe, is it legal? A survey of advice to patients given by orthopaedic surgeons, insurance companies and the police.

Many patients, immobilised in a plaster cast after a fracture of the upper or lower limb, wish to drive. They frequently ask permission to do so from the treating surgeon. Insurance companies are apparently willing to insure these patients to drive if they obtain their doctors permission. The DVLA guidelines are unhelpful in these circumstances. We therefore established current practice within the south west region by canvassing 126 consultant orthopaedic surgeons, 27 insurance companies and the 6 regional police constabularies, sending them specific clinical scenarios and asking how they would advise these patients regarding safety to drive. The results were as follows: sixty-seven (53%) of surgeons responded of which 97% gave specific advice regarding safety to drive. The insurance companies were generally unwilling to respond and a national response was received from the Association of Chief Constables, which specifically stated that safety to drive was for the individual patient to decide and the doctor should not give advice. We consider this to be unsatisfactory for all parties and suggest how this situation could be improved for both the patient and other road users welfare.

Automobile Driving↗