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At least 937 records · Page 52Linked to original sources
PubMed2004

Colour blindness in everyday life and car driving.

PURPOSE: The aim of the present work was to ascertain, through the administration of a psychosocial questionnaire, the difficulties that subjects with defective colour vision experience in carrying out everyday tasks and work, including driving a car with a driver's licence held for no more than 3 years. METHODS: Subjects with defective colour vision (n = 151) and subjects with normal vision (n = 302) completed a psychosocial questionnaire regarding the difficulties associated with congenital colour vision deficiency in daily life, work and driving a car. Subjects were diagnosed as colour-blind using the Ishihara test. RESULTS: Statistically significant differences between the two samples were found for daily life activities. Subjects with defective colour vision preferred daytime driving. At night, subjects with defective colour vision had difficulty identifying reflectors on the road and the rear signal lights of cars ahead of them. CONCLUSION: Colour-blind Calabrian subjects admitted to experiencing colour-related difficulties with a wide range of occupational tasks and leisure pursuits. In particular, colour-blind Calabrian subjects preferred daytime driving, and fewer drove regularly, compared to orthochromatics, who were indifferent to night or daytime driving.

Activities of Daily Living↗
PubMed2006

Driving distance as a barrier to glycemic control in diabetes.

BACKGROUND: Despite advances in treatment of diabetes, many barriers to good glycemic control remain. OBJECTIVE: To determine the relationship between glycemic control and the driving distance from home to the site of primary care. DESIGN: Cross-sectional analysis of data from the Vermont Diabetes Information System. PARTICIPANTS: Nine-hundred and seventy-three adults with diabetes in primary care. The mean age was 64.9 years, 57% were female, and 18.4% used insulin. MEASUREMENTS: Hemoglobin A1c, shortest driving distance from a patient's home to the site of primary care calculated by geographic software, self-reported gender, age, education, income, marital status, race, insurance coverage, diabetic complications, and use of insulin and oral hypoglycemic agents. RESULTS: Controlling for social, demographic, seasonal, and treatment variables, there was a positive, significant relationship between glycemic control and driving distance (beta=+0.07%/10 km, P<.001, 95% confidence interval [CI]=+0.03, +0.11). Driving distance had a stronger association with glycemic control among insulin users (beta=+0.22%/10 km, P=.016, 95% CI=+0.04, +0.40) than among noninsulin users (beta=+0.06%/10 km, P=.006, 95% CI=+0.02, +0.10). CONCLUSION: Longer driving distances from home to the site of primary care were associated with poorer glycemic control in this population of older, rural subjects. While the mechanism for this effect is not known, providers should be aware of this potential barrier to good glycemic control.

Adult↗
PubMed2004

The effects of transdermal fentanyl on driving, cognitive performance, and balance in patients with chronic nonmalignant pain conditions.

OBJECTIVE: To evaluate driving performance, cognition, and balance in patients with chronic nonmalignant pain before and after the addition of transdermal fentanyl to their treatments. DESIGN: Prospective, one-group pretest-posttest design. SETTING: Outpatient pain center associated with a large, urban medical school. INTERVENTIONS: Patients taking less than a 15-mg equivalent of oxycodone per day took baseline driving performance, cognitive, and balance tests. Transdermal fentanyl was initiated and titrated in 25-microg/hour increments, weighing benefits and side effects. At the end of a 1-month period, the achieved dose was maintained for another month. After they were stabilized for 1 month, patients repeated driving, cognitive, and balance tests. RESULTS: Twenty three patients completed the study; three discontinued secondary to side effects. The median dose at the end of the titration period was 50 microg/hour (48%). No differences were found in driving simulation measures between the pretreatment and posttreatment periods. No decrements in cognitive performance were found. Improvements in visual motor tracking, visual memory, and attention were found during treatment with transdermal fentanyl. No differences in balance or body sway were found. Pain decreased over the course of treatment. CONCLUSIONS: The addition of transdermal fentanyl to a treatment regimen containing no opiates or small amounts of opiates for patients with chronic nonmalignant pain did not negatively affect their driving performances, reaction times, cognition, or balance. Future studies in this area are needed to guide treatment decisions.

Administration, Cutaneous↗
PubMedDate not supplied

Driving and epilepsy: a historical perspective and review of current regulations.

Historically, persons with seizures or epilepsy have been prohibited from driving automobiles or motor vehicles because of concern for public safety. Seizures have a tendency to recur and pose risks of traffic accidents, property damage, and personal injury. In our modern world, however, driving an automobile is such an economic and social necessity that a conflict results between our need to protect public safety and our responsibility to provide reasonable opportunities to drive for persons handicapped by seizures and epilepsy. Currently, there is a trend toward liberalization of driving standards for persons with epilepsy, but there is still considerable controversy regarding the specific driving restrictions necessary for persons with seizures, the way in which such policies should be administered, and the role physicians should have in the process.

Accidents, Traffic↗
PubMed2006

Predicting driving cessation over 5 years in older adults: psychological well-being and cognitive competence are stronger predictors than physical health.

OBJECTIVES: To examine psychological, medical, and sensorimotor risk factors that predict driving cessation in older adults. DESIGN: Prospective cohort study including five waves of data collected in 1992, 1993, 1994, 1995, and 1997. SETTING: The Australian Longitudinal Study of Aging. PARTICIPANTS: One thousand four hundred sixty-six men and women aged 70 and older drawn from the electoral roll and including 753 drivers at baseline. MEASUREMENTS: Interviews, including assessments of self-rated health (indicating general well-being); medical conditions; driving status; and clinical assessments of vision, hearing, cognitive function, and grip strength, were conducted in 1992 (baseline) and 1994. Information on current driving status was obtained at baseline and four subsequent waves (1993, 1994, 1995, and 1997). Drivers and nondrivers were compared at baseline. Risk factors for driving cessation were identified using logistic regression. RESULTS: Drivers were younger and more likely to be male and had better self-rated health, vision, hearing, and cognitive performance than nondrivers at baseline. Seventeen percent of drivers in the study had vision of 6/18 or worse, and 7.3% were classified as possibly cognitively impaired. In those identified as drivers at baseline, subsequent cessation was associated with increasing age, low grip strength, poorer cognitive performance, and poorer self-rated health. CONCLUSION: Self-rated health and cognitive function were more important than medical conditions or sensory function for predicting driving cessation.

Age Factors↗
PubMed1998

Impact of melatonin on driving performance.

BACKGROUND: Because millions of people are self-prescribing melatonin for various indications, the safety aspects of this substance have become very important. The aim of our study was to determine whether or not melatonin impairs driving-related performance. METHODS: Twenty healthy men and women aged 21-57 years volunteered for this randomized, placebo-controlled, double-blind, crossover study. The crossover arms were separated by an interval of at least 4 weeks. On each testing day, melatonin 5 mg or placebo was taken at 1630 h; 60 minutes later a test series was performed, consisting of a medical examination, body sway measurement, and a standardized driving computer test battery to assess attention, reaction time, power of concentration, and sensomotor coordination. Subjective sleepiness was measured on three occasions during the test session using the Stanford Sleepiness Scale questionnaire. RESULTS: Just one of the 16 main variables of the driving computer test battery, the selective attention tested by signal-detection, was significantly affected by melatonin (p < .05). However, even those values were still within the normal range. Subjective sleepiness was increased by melatonin, although the result was significant only after the prolonged concentration task (p < .05). Neither the clinical examination nor the body sway test showed signs of any drug influence. CONCLUSIONS: The overall result of the computer test battery showed no objective adverse impact of melatonin on driving performance. However, due to the increased subjective sleepiness after administration of this hormone, caution should be exercised when driving under the influence of melatonin.

Adult↗
PubMed2004

A practical approach to measuring the visual field component of fitness to drive.

AIMS: To determine the level of agreement between merged monocular visual field tests (the integrated visual field) and the binocular Esterman visual field test in classifying patients' visual status for UK legal fitness to drive. To examine the link between these two tests and the useful field of view (UFOV) test, a test which is considered to be a surrogate for the visual capability for safe driving. METHODS: Primary open angle glaucoma patients with bilateral overlapping visual field defects were recruited prospectively. Patients performed the bilateral monocular field tests (to generate the integrated visual field), the Esterman test and the UFOV test on the same visit. Patients were classified as "pass" or "fail" by both the integrated visual field and the Esterman test. UFOV risk scores were calculated for each patient. RESULTS: 65 patients were recruited. Substantial agreement was found between the integrated visual field and the Esterman test in classifying patients as "pass" or "fail" (kappa = 0.69). No patients classified as "pass" by the integrated visual field test were classified as "fail" by the Esterman test. Eight patients who were classified as "pass" by the Esterman test were classified as "fail" by the integrated visual field test. The UFOV risk characteristics of these eight patients suggested they were more similar to those of the 13 patients who were classified as "fail" by both the tests, than the 44 patients who were classified as "pass" by both tests. CONCLUSIONS: The integrated visual field test agrees well with the current method (Esterman) of classifying visual fields with regard to legal fitness to drive in the United Kingdom in patients with glaucoma; it appears superior to the current method in identifying those with reduced fitness to drive as measured by the UFOV. The integrated visual field test could perform a valuable screening or diagnostic role in the assessment of glaucoma patients' fitness to drive.

Adult↗
PubMed1981

Driving performance of retinitis pigmentosa patients.

The driving performance of 42 patients with retinitis pigmentosa (RP) was compared with that of 87 control subjects. Although the patients with RP were involved in more isolated road accidents than the control group, 50% were not involved in any accident over the most recent 5-year driving period. When the associations between driving performance and case/control status were examined (the number of driving hours per week and driving years being taken into account), differences in the number of accidents between the 2 groups were significant because of a disproportionately high number of accidents caused by a subgroup of female RP patients. No significant correlations were apparent between central visual efficiency or peripheral field efficiency and number of road accidents.

Accidents, Traffic↗
PubMed2002

Relation between perceived driving disability and scores of vision screening tests.

AIM: To determine the relation between perceived driving disability and vision screening tests. METHODS: 93 subjects, aged 50 years and over, with binocular visual acuity of at least 20/80. Perceived driving disability (PDD) was assessed by a questionnaire. Subtracting daytime from night-time driving question scores revealed PDD at night (PDDN), subtracting scores of questions for driving in familiar places from those in unfamiliar places revealed PDD at unfamiliar places (PDDU). RESULTS: PDD was strongly related to visual acuity, contrast sensitivity and useful field of view (UFOV). Specific relations existed between PDDN and Nyktotests and Mesotests and between PDDU and UFOV. These associations were enhanced in a subset of subjects with better visual acuities. CONCLUSIONS: Vision screening tests correlate well with perceived driving disabilities, especially when a subtraction method is used in the questionnaire to reveal condition dependent disabilities. Additional tests for visual acuity are useful, especially in subjects with better visual acuity.

Automobile Driving↗
PubMed1971

Epilepsy and driving.

The status of the epileptic applicant for a licence to drive a private motor vehicle has changed from total prohibition through a stage of partial approval subject to medical assessment to the present conditional right to a driving licence. We report a study of a series of patients which shows that many and probably most epileptics have obtained driving licences by concealment of their condition, yet the new regulations continue to expect true declarations. It is suggested that, in common with applicants for a public service vehicle or a heavy goods vehicle driving licence, the applicant for a licence to drive a private motor vehicle should provide a medical report of fitness. The epileptic should be included in a general category of medically restricted drivers subject to individual medical assessment.

Automobile Driver Examination↗
PubMed2003

Driving impairment due to sleepiness is exacerbated by low alcohol intake.

AIMS: To assess whether low blood alcohol concentrations (BACs), at around half the UK legal driving limit, and undetectable by police roadside breathalysers, further impair driving already affected by sleepiness, particularly in young men, who are the most "at risk" group of drivers for having sleep related crashes. METHODS: Twelve healthy young men drove for two hours in the afternoon, in an instrumented car on a simulated motorway. In a repeated measures, counterbalanced design, they were given alcohol or placebo under conditions of normal sleep or prior sleep restriction. Measurements were: driving impairment (lane drifting), subjective sleepiness, and EEG measures of sleepiness. RESULTS: Whereas sleep restriction and alcohol each caused a significant deterioration in all indices, the combined alcohol and sleep restriction further and significantly worsened lane drifting (which typifies sleep related crashes). This combined effect was also reflected to a significant extent in the EEG, but not with subjective sleepiness. That is, alcohol did not significantly increase subjective sleepiness in combination with sleep loss when compared with sleep loss alone. CONCLUSIONS: Modest, and apparently "safe" levels of alcohol intake exacerbate driving impairment due to sleepiness. The sleepy drivers seemed not to have realised that alcohol had increased their sleepiness to an extent that was clearly reflected by a greater driving impairment and in the EEG.

Accidents, Traffic↗
PubMed2005

Useful visual field reduction as a function of age and risk of accident in simulated car driving.

PURPOSE: To study the relationships between the reduction of the useful visual field, age, and driving performance. METHODS: Forty-eight subjects, aged from 23 to 77 years performed a test to evaluate the size of their useful visual fields. The test involved the detection and localization of peripheral signals that could appear in an area of 70 degrees of visual angle. The subjects then performed a simulated car-driving task involving the management of a situation that could lead to an accident. RESULTS: The analysis of the data revealed that the ability to process peripheral signals and simulated driving performance (vehicle speed) deteriorate with age. Simulated driving performance and useful visual field measurement have been analyzed jointly. The results indicate that the reduction of the useful visual field, estimated using a target-localization task, is related to the individual's ability to manage the simulated driving situation (correlation coefficient with speed = -0.43 and with reaction time for avoidance of a mobile obstacle = +0.30) and the deterioration of the useful visual field estimated using a target detection task is related only to vehicle speed (correlation coefficient = -0.32). CONCLUSIONS: The adoption of a lower speed by the drivers with a reduced visual field (the elderly ones) is probably an adaptation strategy to process the peripheral information. All useful visual field measurements do not seem to be equivalent to estimate the ability to process information relative to the mobile obstacle. The risk of collision should be estimated only with a useful visual field test using a target localization task.

Accidents, Traffic↗
PubMed2000

On the receiving end: facilitating the analysis of conflicted drive derivatives of aggression.

Freud's delay in giving aggression an instinctual role comparable to that of libido had clinical effects. Historically, this delay rescued psychoanalysis and its practitioners from destruction by Austria's anti-Semitic leadership. Since today the cultural threat to analysis is of quite a different nature, methods are proposed for making drive derivatives of aggression (and, in turn, libidinal drive derivatives) more accessible. Certain traditional methods have in significant degree distracted analysts from techniques that more effectively allow patients to bring conflicted derivatives of aggression into nonneurotic management through analytically facilitated ego growth. Approaches that move away from the concept of conflicted instinctual drives compound the basic resistance to analyzing defended drive derivatives of aggression. A recommendation is made for a two-tier choice of method: (1) a traditional technique for patients needing relatively less access to their aggression to achieve a satisfying outcome, and (2) close process attention for the analysis of analytic candidates and others for whom it is professionally advantageous to achieve greater insight into their aggressive potential. Recommendations are made regarding how the analyst can attain the neutrality necessary to conduct analyses of the latter sort without having to suffer narcissistic trauma while on the receiving end of verbally explicit, undisplaced drive derivatives of aggression.

Aggression↗
PubMed1993

Epilepsy and driving: attitudes and practices among patients attending a seizure clinic.

Although the loss of freedom to drive is a serious consequence of the diagnosis of epilepsy, it is unclear how well current regulations are understood and adhered to by patients. Using questionnaires completed anonymously, we assessed attitudes and practices among 104 patients with epilepsy. Seventeen (16%) patients were driving, three illegally. In total, eight (8%) patients had at some stage driven illegally, even though seven admitted to having been warned not to do so. Even among the 14 patients currently driving and eligible to do so, only eight (57%) had informed the licensing authority and six (43%) their insurers. Only 34 (33%) patients showed satisfactory knowledge of current regulations, including seven (50%) of those currently driving and 21 (50%) of 42 patients who expressed a wish to drive in the future. Of these 34, only 14 (41%) expressed complete agreement with the regulations. Thus, a significant proportion of patients with epilepsy has driven illegally or has failed to inform the licensing authority or insurers. Understanding of regulations is poor. Less stringent restrictions have been shown to be safe in other countries and might improve compliance.

Adult↗
PubMedDate not supplied

Cost-effectiveness of regulations against using a cellular telephone while driving.

PURPOSE: To evaluate the cost-effectiveness of regulations that prohibit using a cellular telephone while driving a motor vehicle. DESIGN: Decision analysis of risks and benefits related to cellular telephones and driving. SETTING: United States population in 1997. MEASURES: Health benefits measured as the quality-adjusted life years potentially saved. Financial benefits measured as health care and other services potentially averted. Costs of regulation measured as the lost productivity derived from willingness to pay for cellular telephone calls. RESULTS: Under base-case conditions, cellular telephone calls in the United States each day accounted for about 984 reported collisions, 1,729 total collisions, 2 deaths, 317 persons with injuries, 99 lost years of life expectancy, 161 lost quality-adjusted life years, $1 million in health care costs, and $4 million in property damage and other costs. This reflected a total of about 35 million telephone calls while driving, 70 million calling minutes, and $33 million in total value to society. The estimated cost-effectiveness ratio for a regulation restricting cellular telephone usage while driving was $300,000 per quality-adjusted life year saved, but ranged from $50,000 to $700,000 under alternative assumptions and interpretations of data. Regulations applied to teenage males could be cost-saving to society if the value of a call fell below 37 cents per minute. CONCLUSIONS: Regulations restricting cellular telephone usage while driving are less cost-effective for society than other safety measures. Nevertheless, regulations may be justifiable because the benefits and harms do not always involve the individual who has the cellular telephone. Increasing the price of a call (or adding a supplementary tax) might decrease the number of discretionary calls, be cost-saving for society, and be life-saving for individuals.

Accidents, Traffic↗
PubMed2004

Driving and dementia: a review of the literature.

The purpose of this article is to review the literature on the ability of individuals with dementia to drive an automobile. Based on a review of the literature, several factors were identified that may be useful in differentiating between people with dementia who presently remain safe drivers from those who have progressed to impaired driving. These factors include disease duration and severity, sex, patient self-assessment, family assessment, neuropsychological measures, findings on road evaluations, and driving simulator testing. The approach of the physician to driving and dementia is addressed, including in-office screening, referral for on-road driving assessments, and the potential for physician reporting to state agencies.

Aged↗
PubMedDate not supplied

The impact of Alzheimer's disease on driving ability: a review.

As our elderly population continues to increase, diseases that are more prevalent with aging, such as Alzheimer's disease, are assuming ever greater relevance for society and the practicing clinician. An important practical situation faced by physicians caring for individuals with Alzheimer's disease is advising the affected individuals, their families, and often the licensing authorities about whether the patient can safely drive an automobile. Surprisingly, there is little guidance on how to arrive at a clinical impression of the fitness of an individual with Alzheimer's disease to drive. This article outlines potential inadequacies in driving skills that may occur with elderly people in general, and more specifically those with Alzheimer's disease. Studies that focused on Alzheimer's disease and driving are then reviewed. We conclude with recommendations for dealing with the problem of driving abilities in Alzheimer's disease.

Accidents, Traffic↗
PubMed2003

Evaluating alleged drinking after driving--the hip-flask defence. Part 2. Congener analysis.

The second part of this review describes the principles and practice of forensic congener analysis as an alternative way to evaluate claims of drinking alcohol after driving. Congener analysis was developed, perfected and practised in Germany as a way to evaluate hip-flask defences. This kind of defence challenge arises frequently when the drunk driving suspect is not apprehended at the wheel and especially after hit-and-run incidents. Besides ethanol and water, alcoholic beverages contain trace amounts of many other low-molecular substances, known collectively as the congeners, which impart the characteristic smell and taste to the drink. Importantly, the congener profile can be used to identify a particular kind of alcoholic beverage. Forensic congener analysis entails making a qualitative and quantitative analysis of ethanol, methanol, n-propanol and the isomers of butanol in blood and urine from the apprehended driver and comparing the results with the known congener profile of the alcoholic beverage allegedly consumed after driving. Interpreting the results of congener analysis requires knowledge about the absorption, distribution and elimination pattern of the congener alcohols, including their oxidation and conjugation reactions, and any metabolic interactions with ethanol. Complications arise if drinks with widely different congener profiles are consumed or if the same beverage was ingested both before and after driving. Despite these limitations, congener analysis can furnish compelling evidence to challenge or support claims of drinking alcohol after driving.

1-Propanol↗