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PubMed1998

Driving with a visual impairment.

Driving is a highly prized activity for individuals of all ages. The decision to continue driving after a decrease in central acuity or visual field can be a source of anxiety for the individual and his or her family, as well as the ophthalmic practitioner. Although a great deal of research has been done concerning vision and driving, much controversy still surrounds this subject. This article reviews the literature concerning visual impairment and driving and makes suggestions for what should be considered when determining who should and should not continue to drive.

Automobile Driver Examination↗
PubMed2002

Epilepsy and motor vehicle driving--a symposium held in Québec City, November 1998.

BACKGROUND: This report summarizes an invitational symposium on epilepsy and Canadian laws governing motor vehicle driving held in Québec City in November 1998. METHODS: Invited neurological experts from Canada, the USA, and Europe; and representatives of provincial and territorial licensing bodies, the Canadian Council of Motor Transport Administrators, the Canadian Medical Protective Association, and the Canadian Medical Association participated. An edited version of transcribed audiotapes was prepared. Specific issues discussed were whether or not a physician should be required to report a patient with epilepsy to the licensing authority (mandatory reporting), the nature and quantification of the risks posed by epileptic drivers, and what would be a reasonable law regulating driving by people with epilepsy in Canada. RESULTS: The consensus among medical experts was that mandatory reporting should be abolished in Canada and that a 6-12 month seizure-free period was appropriate before most patients could return to driving private cars. Experts also believed that these standards should be uniform across Canada. There was strong disagreement with the recommendation of the Canadian Medical Association that all such drivers be reported to provincial licensing authorities even in provinces without mandatory reporting rules. CONCLUSIONS: Physicians should be familiar with and follow the rules regarding epilepsy and driving in the provinces where they practice. Nevertheless, current evidence is against mandatory physician reporting of drivers with epilepsy and the neurologists recommended that this be abolished throughout Canada. Shorter seizure-free intervals should also be considered before resuming driving of private cars.

Automobile Driving↗
PubMed1997

Epilepsy and driving: a survey of Canadian neurologists.

BACKGROUND: A seizure is the most common cause of loss of driving privileges for medical reasons but there is variability in how physicians and the authorities who regulate driving approach this issue. METHODS: A questionnaire regarding epilepsy and driving was sent to all adult neurologists in Canada (n = 494). RESULTS: Of 289 (59%) neurologists responding, 50% usually report patients with seizures to the department of motor vehicles compared to only 4% for stroke/TIA, 26% for dementia and 8% for other neurologic disorders (p < 0.0001). In the five provinces with mandatory reporting laws, seizures were reported most of the time by 84% compared to only 19% in the five provinces with discretionary reporting (p < 0.0001). Nationwide, 44% agreed with mandatory reporting but this also differed in provinces with and without mandatory reporting legislation (63% vs. 37%, p < 0.0001). Only 49% agreed with the current recommendation of at least one year seizure free interval before resuming driving. CONCLUSIONS: Seizures are disproportionately reported compared to other neurological conditions. Many neurologists disagree with the recommended Canadian standards for duration of driving restriction after seizures. Variability in the attitude and practice of neurologists in regard to reporting of seizures is confirmed.

Adult↗
PubMed1999

Understanding the use of a community-based drive-home service after alcohol consumption among young adults.

To know and understand the intention of young adults to use, during the Christmas and New Year's period, the community drive-home service after drinking alcohol, that is, to phone for oneself when they are the driver or when they are the passenger to suggest to a friend who is the driver to phone for the service. This study was conducted in the Province of Quebec, Canada, among a representative sample of 544 young adults aged 18 to 24 years. Self-administered questionnaires were completed by mail. Young adults showed a very good knowledge of the drive home service and had a very positive attitude toward its use. Among those who reported having experienced drinking too much alcohol during the Christmas and New Year's period, 17 percent had phoned when they were the driver and 36 percent had, when they were a passenger, suggested to a friend who was the driver to phone the community drive-home service. Nonetheless, more than half of them intended to use or to recommend its use to a friend in the future. Several factors identified in this study might be useful for increasing this drive-home service and therefore, contribute to lowering the risk of injury related to alcohol-impaired driving among young adults.

Accidents, Traffic↗
PubMed2000

Risky driving behavior: a consequence of motion adaptation for visually guided motor action.

The authors examined the effect of adaptation to expansion on overtaking maneuvers in a driving simulator. Following driving on a straight empty road for 5 min, drivers initiated overtaking substantially later (220-510 ms) than comparable maneuvers made following viewing a static scene or following 5 min of curve driving. Following adaptation to contraction (produced by driving backward), observers initiated overtaking significantly sooner. The removal of the road texture significantly reduced the size of the adaptation effect. The authors propose that these changes in overtaking behavior are due to misestimation of the time headway produced by local adaptation of looming detectors that signal motion-in-depth for objects near the focus of expansion. This adaptation effect may increase the risk of rear-end collisions during highway driving.

Adaptation, Psychological↗
PubMed2003

Visual acuity and legal visual requirement to drive a passenger vehicle.

OBJECTIVES: (1). To test the consistency and ease with which number-plates of different component figures can be read under DVLA driving test conditions; (2). to test the relative difficulty of reading corresponding figures on registration plates of white and yellow backgrounds.Design Prospective study of consecutive eligible clinic patients. SETTING: Ophthalmology outpatients. SUBJECTS: 210 individuals with a corrected visual acuity with both eyes open of between 6/9 and 6/12. MAIN OUTCOME MEASURES: The ability to read three different number-plates under standard DVLA driving-test conditions (ie at 20.5 m in good daylight with glasses if worn) and the ability to read identical number-plates against a white and a yellow background. RESULTS: There is a significant difference between the ease with which three different number-plates can be read depending on their letter and numeral composition, although this did not seem to be significantly affected by whether they were printed on a yellow or white background. Only 92.3% of subjects could read all the number-plates at the legal distance, 96.7% could read at least one number-plate at the legal distance and 3.3% of the test subjects could not read any of the number-plates at 20.5 m. CONCLUSIONS: The current test protocol used to obtain a driving licence and, moreover, the test the police will employ to assess visual competence to drive, is highly variable and is unlikely to give consistent repeatable results. The performance of those with equally good visual acuity is unpredictable and is highly dependent on the number-plate they are asked to read. This variability could exclude some who would otherwise pass the test or pass an individual with a visual acuity below accepted standards. The forthcoming changes in the regulations for design of number-plates is an ideal opportunity to standardise the whole testing procedure for driving visual acuity.

Adult↗
PubMed2006

Driving to work and overweight and obesity: findings from the 2003 New South Wales Health Survey, Australia.

OBJECTIVES: To examine possible associations between driving to work, physical activity and overweight and obesity. DESIGN: Secondary analysis of cross-sectional data from a representative sample of the 2003 New South Wales Adult Health Survey, Australia. SUBJECTS: A total of 6810 respondents aged 16 years or over. MEASUREMENTS: Self-reported height and weight, modes of transport to work, level of physical activity, fruit and vegetable intake and social-economic status. RESULTS: Almost half of the respondents (49%) were overweight. The main mode of transport to work was driving a car (69%), 15% used public transport, 7% walked, 2% cycled and 6% worked at home. People who drove to work were less likely to achieve recommended levels of physical activity compared to non-car users (56.3 vs 44.3%, chi2 = 82.5, P<0.0001). Driving to work was associated with being overweight or obese (adjusted odds ratio = 1.13 (95% CI 1.01-1.27), P = 0.047). Inadequate level of physical activity was independently associated with overweight or obesity. Socially and economically disadvantaged people were also more likely to be overweight and obese. In addition, being female or never married or having higher level of education was associated with a significantly reduced odds ratio of being overweight or obese, as was speaking a language other than English at home. No association was found between weight status and recommended vegetable or fruit intake. CONCLUSIONS: Driving to work is the dominant mode of commuting in a modern society and its impact on health requires scrutiny. The association found in this study between driving to work and overweight and obesity warrants further investigation to establish whether this relationship is causal. If proved as such, then promoting active transport modes such as walking, cycling and public transport should form a key component of global obesity prevention efforts.

Adolescent↗
PubMed2004

Alcohol intoxication effects on simulated driving: exploring alcohol-dose effects on brain activation using functional MRI.

Driving while intoxicated is a major public health problem. We investigated impaired driving using a simulated driving skill game that presents an 'in-car' view of a road and a readout of speed. We explored brain activation and behavioral alterations from baseline at two blood alcohol concentrations (BACs). Participants received single-blind individualized doses of beverage alcohol designed to produce blood alcohol content (BAC) of 0.04 and 0.08 or placebo. Scanning occurred on a 1.5 Tesla Philips MRI scanner after training to asymptote performance. Analysis was performed using independent component analysis (ICA) to isolate systematically nonoverlapping 'networks' and their time courses. Imaging results revealed seven separate driving-related brain networks with different time courses. Several significant findings were observed for the imaging data. First, dose-dependent functional magnetic resonance imaging (fMRI) changes were revealed in orbitofrontal (OF) and motor (but not cerebellar) regions; visual and medial frontal regions were unaffected. Second, cerebellar regions were significantly associated with driving behavior in a dose-dependent manner. Finally, a global disruptive effect of alcohol on the ICA time courses was observed with highly significant differences in OF and motor regions. Alcohol thus demonstrated some behavioral effects and unique, disruptive, dose-dependent effects on fMRI signal within several brain circuits. The fMRI data also suggest that the deficits observed in alcohol intoxication may be modulated primarily through OF/anterior cingulate, motor and cerebellar regions as opposed to attentional areas in frontoparietal cortex.

Adult↗
PubMed1999

Drink driving and criminal behaviours as risk factors for receipt of disability pension and sick leave: a prospective study of young men.

AIM: To examine the extent to which drink driving and criminal behaviour would predict receipt of disability pension and high sickness absence rates in young and middle-aged men. DESIGN AND SETTING: A total of 8122 mandatory conscripts, born in 1950 or 1951, from the County of Stockholm were followed in a 22-year longitudinal study. Information was collected at the time of conscription for military service in 1969 and 1970. Data were linked to records on driving while intoxicated (DWI) and other criminal offences between 1970 and 1991 and to information from the Social Insurance Board. FINDINGS: A total of 211 (2.6%) conscripts were granted a disability pension during the follow-up period between 1970 and 1991, and another 373 (4.6%) conscripts had high sickness absence (at least 180 sick days between 1989 and 1991). A total of 642 men had one or more DWI offences from the time of conscription until 1992. The median number of sick-days/sick-listed between 1989 and 1991 was 35.0 for men who were problem drinkers at conscription, 60.3 for drink drivers, 31.0 for men with less serious and 53.0 for men with serious crimes, compared to 21.0 days for the group as whole. In bivariate regression analysis, drink driving implied a relative risk (RR) of a disability pension/high sickness absence of 3.4 (95% CI: 2.8-4.1), and criminality a RR of 3.6 (95% CI: 3.1-4.1). In multivariate logistic regression analysis, controlling for psychosocial factors from conscription and for criminality, drink driving remained a strong predictor (RR 2.1, 95% CI: 1.7-2.7). CONCLUSIONS: Problem drinking, drink driving and criminality are important risk factors for receipt of disability pension and high levels of sickness absence in young men. The findings suggest that preventive efforts undertaken at the time of conscription and during later military service may pay dividends in term of preventing problems later in life.

Adolescent↗
PubMed2002

Insulin-treated diabetes and driving in the UK.

Diabetes, and particularly insulin-treated diabetes, has important implications for motor vehicle driving, largely because of its association with potential hypoglycaemia. For this reason, most countries operate some driving restrictions on insulin-treated diabetic patients, as well as systems of intermittent reassessment of hypoglycaemic risk. In the UK, regulations are operated by the Driver and Vehicle Licensing Agency (DVLA), which is an agency of the Department of the Environment, Transport and the Regions (DETR). They are supported by an Expert Panel which advises the Secretary of State on diabetes-related issues relating to fitness to drive. The patient organization Diabetes UK is also concerned with diabetes and driving issues, largely from a position of lobbying policy-influencers and supporting individual cases. All parties involved with diabetes and driving issues recognize the need for more research on the subject, as the current literature is flawed in design, though no convincing excess of accidents amongst diabetic drivers has been conclusively demonstrated. Currently in the UK, Class 2 vehicles (large trucks and passenger vehicles) are barred to diabetic drivers on insulin. European law has recently extended this to so-called C1 (large vans and small lorries) and D1 (minibuses) vehicles, though the law has recently been revised to allow individual consideration for potential diabetic C1 drivers on insulin treatment. Diabetes and insulin-treated diabetes is an emotive and difficult issue, for which a stronger evidence base is urgently needed.

Automobile Driving↗
PubMed2003

Longitudinal driving performance in early-stage dementia of the Alzheimer type.

OBJECTIVES: To longitudinally assess on-road driving performance in healthy older adults and those with early-stage dementia of the Alzheimer type (DAT). DESIGN: A prospective longitudinal study. SETTING: Large urban medical center and surrounding area. PARTICIPANTS: A sample of 58 healthy controls, 21 participants with very mild DAT, and 29 participants with mild DAT participated. DAT was diagnosed using validated clinical diagnostic criteria and staged according to the Clinical Dementia Rating (CDR) Scale. MEASUREMENTS: Healthy controls and individuals with very mild DAT and mild DAT were administered a standardized on-road driving assessment over repeated times of testing. RESULTS: Subjects in the CDR=1 group (mild DAT) had a faster rate of receiving a rating of not safe on the driving test than subjects in the CDR=0 group (healthy controls; log rank test, P=.006), and the survival function of the CDR=0.5 group (very mild DAT) fell between those of the CDR=0 and CDR=1 groups. A Cox proportional hazards model indicated a significant difference in survival functions between the CDR=0 and CDR=1 groups after baseline age was controlled for (P<.001). Cox regression analysis also indicated that baseline age was a significant risk factor for a rating of "not safe" (P=.002). CONCLUSION: This study provides longitudinal evidence for a decline in driving performance over time, primarily in early-stage DAT, and supports the need not only for driving assessments, but also for reevaluation of individuals with very mild and mild DAT.

Aged↗
PubMed2003

Effectiveness of a visual attention retraining program on the driving performance of clients with stroke.

OBJECTIVE: To compare the effectiveness of a visual attention retraining program using the Useful Field of View (UFOV) with a traditional visuoperception treatment program on the driving performance of clients with stroke. DESIGN: Randomized controlled trial. SETTING: Rehabilitation hospital located in Quebec, Canada. PARTICIPANTS: Ninety-seven individuals referred for driving evaluation after a stroke. INTERVENTIONS: Participants were randomized to receive 20 sessions of either UFOV training of visual processing speed, divided attention, and selective attention or traditional computerized visuoperception retraining. MAIN OUTCOME MEASURES: Subjects were evaluated with an on-road driving evaluation, visuoperception tests, and the Test of Everyday Attention. An occupational therapist unaware of group assignment conducted all evaluations. RESULTS: Eighty-four participants completed the outcome evaluation. There were no significant differences between groups on any of the outcome measures. There was, however, almost a 2-fold increase (52.4% vs 28.6%) in the rate of success on the on-road driving evaluation after UFOV training for subjects with right-sided lesions. CONCLUSIONS: Rehabilitation that targets visual attention skills was not significantly more beneficial than traditional perceptual training in improving the outcome of an on-road driving evaluation. However, results suggest a potential improvement for subjects with right-sided lesions, indicating that training must target specific skills.

Aged↗
PubMed1996

Role of formal instruction and informal practice in learning to drive.

Learning to drive a motor vehicle is important for the mobility of the majority of people in industrialized countries. Although a great deal is known about the acquisition of psychomotor skills in the laboratory and in some other practical settings, there has been little scientific study of learning to drive. One major practical question concerns the value of formal tuition with a qualified instructor and informal practice with friends or relatives. This paper reports a cross-sectional study of 805 learner drivers in the UK who had undergone at least 5 h of formal tuition to examine associations between their history of formal tuition and practice and current levels of skill and confidence as assessed by both pupils and their instructors. The results indicated an increase in instructor ratings of pupil skill with both increasing practice and tuition. However, the relationship between tuition and instructor-rated skill was only observed in pupils who had had no practice. Pupils' self-confidence did not increase with either tuition or practice; instructors' feelings of confidence in and safety with the pupil increased with pupils' prior hours of practice but not tuition. Instructors' ratings of the likelihood that pupils would pass the driving test first time were positively associated with prior hours of practice and negatively associated with prior formal tuition. The results suggest that informal practice constitutes an important element of the process of learning to drive. Longitudinal and experimental studies are now required to confirm this finding and to establish whether recommendations should be made for a component of driving tuition involving supervised practice.

Adolescent↗
PubMed1976

Acquired drive strength as a joint function of UCS intensity and number of CS-UCS pairings: the effect of masses and distributed CS-UCS pairings.

The empirical law relating acquired drive strength, as measured by the latency of a hurdle-jump response, to UCS intensity and number of CS-UCS pairings was investigated. The effect on acquired drive strength of varying the intervals between successive CS-UCS pairings was also investigated. Ss were 150 male albino rats, 125-160 days old. The apparatus was the classically conditioned fear apparatus. Acquired drive strength was found to be curvillinearly related to UCS intensity and number of CS-UCS pairings when a 10 minute intertrial interval was used. The relationships were monotonic and hegatively accelerated. The effect of UCS intensity on acquired drive strength varied with the length of the intertrial interval. The findings of diverging functions relating UCS intensity to test trials support Spence's notion of multiplicative relationship between habit strength (sHr) and drive (d) in the determination of performance in aversive conditioning.

Animals↗
PubMed2006

UFOV performance and driving ability following traumatic brain injury.

PRIMARY OBJECTIVE: To investigate the relationship between performance on the Useful Field of View Test (UFOV) and driving performance following traumatic brain injury (TBI). PARTICIPANTS: Sixty people with TBI referred for driving evaluation. MEASURES: Useful Field of View Test, Global Rating Scale and Driver Assessment Scale. RESULTS: Subject performance diminished as the complexity of the UFOV sub-tests increased. There was a significant relationship between UFOV performance, particularly on the second sub-test, and on-road driving performance. Subject age and Trail Making Test, Part B were also predictive of driving performance. CONCLUSIONS: The UFOV can be used as a screening measure to determine readiness to participate in an on-road driving assessment.

Adolescent↗
PubMed2002

Task-induced fatigue states and simulated driving performance.

States of fatigue are implicated in driver impairment and motor vehicle accidents. This article reports two studies investigating two possible mechanisms for performance impairment: (1) loss of attentional resources; and (2) active regulation of matching effort to task demands. The first hypothesis predicts that fatigue effects will be accentuated by high task demands, but the second hypothesis predicts that fatigue effects will be strongest in "underload" conditions. In two studies, drivers performed a stimulated driving task, in which task demands were manipulated by varying road curvature. In a "fatigue induction" condition, the early part of the drive was occupied by performance of a demanding secondary task concurrently with driving, after which the concurrent task ceased. Post-induction driving performance was compared with a control condition in which drivers were not exposed to the induction. In both studies, the fatigue induction elicited various subjective fatigue and stress symptoms, and also raised reported workload. Fatigue effects on vehicle control and signal detection were assessed during and after the fatigue induction. The fatigue induction increased heading error, reduced steering activity, and, in the second study, reduced perceptual sensitivity on a secondary detection task. These effects were confined to driving on straight rather than on curved road sections, consistent with the effort regulation hypothesis. The second study showed that fatigue effects were moderated by a motivational manipulation. Results are interpreted within a control model, such that task-induced fatigue may reduce awareness of performance impairment, rather than reluctance or inability to mobilize compensatory effort following detection of impairment.

Adolescent↗
PubMedDate not supplied

Reckless driving and gender: an examination of a terror management theory explanation.

A study, based on Terror Management Theory, examined the effects of mortality salience on young men's and women's behavioral intentions to drive recklessly. Participants (N = 206) reported on the relevance of driving to their self-esteem. Half of them were exposed to a mortality salience induction and the remaining to a control condition. Then they were asked about their willingness to drive recklessly in various scenarios. Findings showed that mortality salience led to higher intentions to drive recklessly than the control condition only among men who perceived driving as relevant to their self-esteem. No such differences were found among women. Results are discussed in light of the self-enhancing and cultural-world views-validating mechanisms proposed by the Terror Management Theory.

Accidents, Traffic↗
PubMed2005

A driving cycle for vehicle emissions estimation in the metropolitan area of Mexico City.

A driving cycle derived from driving behavior and real traffic conditions in Mexico City (MC) is proposed. Data acquisition was carried out over diverse MC routes, representing travel under congested and uncongested conditions, using the chase-car approach. Thirteen different on-road patterns, including the four main access roads to MC, trips in both directions and different timetables, a total of 108 trips spanning 1044 km were evaluated in this study. The MC cycle lasts 1360 seconds with a distance of 8.8 km and average speed of 23.4 km h(-1). Both maximum speed (73.6 km h(-1)) and maximum acceleration (2.22 km h(-1)s(-1)) are lower than those of the new vehicles certification employed in Mexico ,FTP-75 cycle., that is, the MC cycle exhibits less cruising time and more transient events than the FTP cycle. A total of 30 light duty gasoline vehicles were classified into different technological groups and tested in an FTP-75 and MC driving cycles in order to compare their emission factors A potential concern is that in Mexico manufacturers design vehicles to meet the emission standards in the FTP, but emission levels increase significantly in a more representative cycle of present driving patterns in the Metropolitan Area of Mexico City (MAMC). The use of a more representative cycle during certification testing, would provide an incentive for vehicle manufacturers to design emissions control systems to remain effective during operation modes that are not currently represented in the official test procedures used in the certification process. Based on the results of the study, the use of MC cycle, which better represents current day driving patterns during testing of vehicle fleets in emissions laboratories, would improve the accuracy of emissions factors used in the MAMC emissions inventories.

Air Pollutants↗