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PubMed2003

Ethnic differences in driving after drinking and riding with drinking drivers among adolescents.

BACKGROUND: This study examined the relationship between ethnicity and driving after drinking (DD) and riding with drinking drivers (RWDD) while controlling for drinking patterns, driving practices, and background demographic characteristics including age and gender. METHODS: Using random-digit dialing procedures, 1534 young adults ranging from 15- to 20-years of age(mean = 17.6) living in California were recruited to participate in a telephone survey. Latinos, African Americans, and Asian Americans were oversampled to allow cross-group comparisons. RESULTS: Rates of DD were lower for females than for males and were also lower for African Americans and Asian Americans than for whites. However, after we controlled for drinking patterns and driving practices, the results showed Latinos at greater risk for DD than white adolescents. Compared with whites and males, Asian American and female adolescents were less likely to report RWDD. When drinking patterns and driving practices were taken into account, Latino adolescents were nearly twice as more likely to ride with drinking drivers than whites. CONCLUSIONS: These findings indicate a greater need for directing prevention efforts to target Latino youth and youth at risk. Moreover, research aimed at elucidating the social and environmental factors involved in the low prevalence rates of DD and RWDD among Asian American youth may indicate possible protective factors to DD and RWDD operating within the Asian American community.

Adolescent↗
PubMed2005

The role of retinal adaptation in night driving.

PURPOSE: Driving is essentially a visuomotor task, and there is now compelling evidence that the disproportionate number of road accidents under night driving conditions is linked to changes in visual performance resulting from reduced lighting. The objective of this article is to establish the extent to which vision is either rod-or cone-dominated under night driving conditions. METHODS: Visual thresholds are measured under lighting conditions that simulate urban lighting. Dark adaptation curves are obtained under three ambient lighting conditions ranging from low (0.1 cd/m) to high (5 cd/m) mesopic levels of retinal adaptation using circular discs of different sizes (1 degree, 2 degrees, 3 degrees, and 5 degrees) presented at retinal eccentricities of 0 degrees, 10 degrees, 20 degrees, 30 degrees, and 40 degrees. RESULTS: The dark adaptation curves exhibit the classic inflection point between rod and cone activity for the lower levels of ambient illumination but a simple monophasic function for the high mesopic levels (>0.5 lux). Adaptation rates are four times faster for the higher compared with the lower illumination level and twice as fast for central compared with peripheral presentation. CONCLUSIONS: The data suggest that vision is mediated by cone pathways at 5 lux and by rod pathways at 0.5/0.1 lux. This shift does not profoundly affect sensitivity, but because rod pathways are known to be slower than cone pathways, it will certainly affect observers' ability to respond to rapidly changing viewing conditions such as are encountered when driving at night.

Adult↗
PubMed1997

Driving skills after whiplash.

Previous studies have shown that some persons with longlasting problems after whiplash have changed eye movements. These changes have been related to disturbance of the posture control system. The question raised in the present study is whether such disturbances can influence daily life functions connected with balance, position and external movements, such as car driving. A group of 23 persons with disturbed eye movements due to whiplash injury, was tested in a driving simulator, together with a closely matched control group. The results revealed significant differences between the two groups with respect to response times to the traffic signs presented, identification of type of sign, as well as steering precision while the subjects' attention was directed to the process of identifying the signs. Alternative explanations such as driving experience, pain, medication or malingering are at least partly controlled for, but cannot completely be ruled out. A distorted posture control system leading to disturbance of eye movements seems to be the most likely primary causative factor, but these disturbances are most certainly complexly determined. Reduced attention capacity is considered to be a mediating secondary factor. Registration of eye movements may be a useful diagnostic tool to evaluate driving skill after whiplash.

Adult↗
PubMed2000

Comprehensive driving assessment: neuropsychological testing and on-road evaluation of brain injured patients.

The study investigates the correspondence between neuropsychological test results and on-road driving performance among 55 patients with a CT-verified brain damage or documented neurological disorder (cerebrovascular accident: 43, traumatic brain injury: 5, multiple sclerosis: 4, other: 3). 5 patients showed unimpaired test profiles and passed the on-road evaluation. 18 patients showed severe neuropsychological deficits contrary to driving and were not recommended for on-road evaluation. Of the remaining 32 patients with some neuropsychological deficits, all 100% in the minor impaired group (n = 8) passed the driving evaluation, compared to 69% in the mildly impaired (n = 16) and 38% in the moderately impaired group (n = 8). Measures of reduced visuoconstructive ability, reaction time, visual attention, and awareness of cognitive impairments, were found to discriminate between groups. It is concluded that neuropsychological assessment of targeted functions provide an ecological valid prediction of driving skill after brain damage, but that on-road evaluation is needed as supplement in cases with ambiguous test findings.

Automobile Driving↗
PubMed2004

Risk perceptions of mobile phone use while driving.

Numerous governments have introduced regulations governing the use of mobile (cellular) telephones while driving. Despite significant research into the "objective" risks, there is relatively little research into risk perceptions either in relation to other in-car distractions or with respect to the factors underlying such perceptions. The current article reports on two studies addressing these issues. Study 1 (N= 199) found that whereas the use of hand-held sets is seen as one of the riskiest activities to perform while driving, the risks of using a hands-free kit are perceived to be relatively small. Study 2 (N= 1,320) found that nearly half of all drivers in the sample with a mobile phone reported having used it while driving and that, overall, the probability of having an accident was perceived to be less for oneself than for one's peers, indicating an optimistic bias. Two factors underpinned risk perceptions, "impact" including perceived severity and equitability, and "controllability" including immediacy, detectability, and probability. While higher "impact" scores were associated with increased preferences for restrictions on the use of hand-held mobiles while driving, the "controllability" scores moderated this relationship such that when perceived "controllability" was low, restriction preferences were high irrespective of perceived "impact." However, when "controllability" was high, restriction preferences remained high when "impact" was high but were low when "impact" was low. Given the growing number of in-car technological innovations, it is suggested that regulators act strategically, rather than finding themselves developing a series of "hazard-specific" regulations, which may ultimately lack coherence.

Automobile Driving↗
PubMed1993

Acute and subchronic effects of the H1-histamine receptor antagonist ebastine in 10, 20 and 30 mg dose, and triprolidine 10 mg on car driving performance.

1. The effects of a new antihistamine, ebastine (10, 20 and 30 mg), on several parameters of driving performance in actual traffic were studied in 15 healthy male volunteers. Subjects were treated for 5 days, and their driving performance tested on day 1 and day 5. The study was double-blind, placebo controlled and included the antihistamine triprolidine (10 mg sustained release) as an active drug control. 2. General tolerability was good except in one case following the reference compound triprolidine. No significant changes in driving performance were found with the new antihistamine ebastine at any dosage, on day 1 or day 5. Triprolidine (10 mg) significantly increased both the amount of weaving and the delay in following speed manoeuvres of a leading car, compared with placebo. 3. The results suggest that ebastine in doses up to 30 mg may be relatively safe for use by those who drive motor vehicles while under medication. The results do not warrant such a conclusion for triprolidine 10 mg.

Adult↗
PubMed1996

Sleepiness and driving: the experience of UK car drivers.

A postal questionnaire survey aimed at exploring the relationship between accidents and daytime sleepiness was sent to 9000 male drivers of which 4621 (51.3%) responded (mean age 47.7, SD 17.1). Drivers provided details of the accidents they had experienced in the last 3 y, and identified those factors, including tiredness, they thought contributed to the accident. In addition, drivers completed the Epworth scale measuring daytime sleepiness and reported whether they had felt close to falling asleep whilst driving during the past 12 mo. Analysis of the data showed that 29% of drivers had felt close to falling asleep at the wheel in the last 12 mo, the probability of which depended on Epworth score, age, occupational group, annual mileage, the proportion of time spent driving on motorways and in built-up areas, how long the driver is prepared to drive before taking a break, and whether the driver is driving a company car or not. Overall, about 7% of accident 'involvements' were associated with tiredness (representing 9-10% of accidents)-a figure which is higher on motorways than on rural roads or built-up roads and higher still in the early hours of the morning. Accident rates of company car drivers and/or those who have felt close to falling asleep at the wheel in the last year are shown to be associated with daytime sleepiness. For example, a company car driver who has felt close to falling asleep at the wheel in the last 12 mo and who scores highly on the Epworth scale has an accident liability which is 70% higher than a similar driver who scores zero on the Epworth scale. Snoring every night increases accident liability by about 30%.

Accidents, Traffic↗
PubMed2006

Subjective sleepiness, simulated driving performance and blink duration: examining individual differences.

The present study aimed to provide subject-specific estimates of the relation between subjective sleepiness measured with the Karolinska Sleepiness Scale (KSS) and blink duration (BLINKD) and lane drifting calculated as the standard deviation of the lateral position (SDLAT) in a high-fidelity moving base driving simulator. Five male and five female shift workers were recruited to participate in a 2-h drive (08:00-10:00 hours) after a normal night sleep and after working a night shift. Subjective sleepiness was rated on the KSS in 5-min intervals during the drive, electro-occulogram (EOG) was measured continuously to calculate BLINKD, and SDLAT was collected from the simulator. A mixed model anova showed a significant (P < 0.001) effect of the KSS for both dependent variables. A test for a quadratic trend suggests a curvilinear effect with a steeper increase at high KSS levels for both SDLAT (P < 0.001) and BLINKD (P = 0.003). Large individual differences were observed for the intercept (P < 0.001), suggesting that subjects differed in their overall driving performance and blink duration independent of sleepiness levels. The results have implications for any application that needs prediction at the subject level (e.g. driver fatigue warning systems) as well as for research design and the interpretation of group average data.

Adult↗
PubMed1991

Epilepsy and driving: a survey of automobile accidents attributed to seizure.

From results of a survey of 72 epileptic car drivers who had a mean driving history of 8.6 years, 18 (25%) had experienced one or more automobile accidents ascribed to a seizure while driving, with the total number of accidents of the surveyed group amounting to 35. All the drivers were known to have partial epilepsy, 13 of them having temporal lobe epilepsy. The main characteristics of these 35 accidents were as follows: (1) Fifty-seven percent were caused by complex partial seizure without an aura in which consciousness was immediately impaired at onset, while about 10% were attributed to simple partial seizure in which the conscious state was not altered. No accident was caused by a first seizure; (2) Fifty-one percent occurred on an empty road with little pedestrian and/or vehicular traffic; (3) In about half the accidents, the driver's vehicle collided against an immovable object, and only 20% involved crashing into another car; (4) Most accidents caused damage to only the driver's car and/or mild physical injury; and (5) Fifty-four percent of the accidents were not reported to the police, and many that were reported were ascribed to driving while asleep, to careless driving or to similar behavior.

Accidents, Traffic↗
PubMed2005

Rate of return to work and driving following arthroscopic subacromial decompression.

BACKGROUND: The aim of the present paper was to evaluate the return to work and return to driving of a cohort of patients undergoing arthroscopic subacromial decompressions +/- arthroscopic acromioclavicular joint excision. METHODS: Arthroscopic subacromial decompressions +/- arthroscopic acromioclavicular joint excision were performed in 68 patients between February 2000 and November 2000. All patients had symptoms of subacromial impingement +/- acromioclavicular joint arthrosis for more than 6 months that had not settled with conservative treatment. All had positive local anaesthetic injection tests. All patients were followed up at 3 weeks and 3 months postoperatively. Their Constant-Murley score was measured preoperatively and at 3 weeks and 3 months postoperatively. Patients were asked to record when they had returned to work and when they had returned to driving. RESULTS: Only one non-manual worker did not return to work within 6 weeks. Eighty-five per cent of manual workers returned to manual work within 3 months. Fifty-one patients held driving licences. The average time to return to driving was 28.9 days. Average preoperative Constant-Murley scores were 47.5 (20-67). At 3 weeks postoperation average Constant-Murley scores were 66.8 (40-92), and at 3 months 76.5 (48-99).

Acromioclavicular Joint↗
PubMed1998

Safe driving education programs at school: lessons from New Zealand.

The self-reported driving and passenger behaviours of senior high school students in Auckland, New Zealand, were assessed prior to and about four months after a school-based program for driver education. The intervention group (n = 176) received a program of 10, one-hour sessions dealing with knowledge, attitudes and judgements relating to safe driving. A control group (n = 146) did not receive any formal driving safety education. Analyses of pre-treatment and follow-up questionnaire responses revealed that both the intervention and control groups showed significant improvements in knowledge about safe driving over time. Males reported more risky attitudes and behaviours than females throughout the study. There were no significant differences between the intervention and control groups on any measures. In discussing these findings, particular attention is paid to the program content and the social context in which such interventions are carried out.

Adolescent↗
PubMed2005

Use of prisms for navigation and driving in hemianopic patients.

PURPOSE: (1) To compare the outcomes of orientation and mobility and driving training with Fresnel prisms and the Gottlieb Visual Field Awareness System for patients with homonymous hemianopsia, and (2) To determine whether the patients continue to use the optical enhancement devices at a 2-year follow-up point. METHODS: Patients with homonymous hemianopsia were provided with a rehabilitation program where they were fitted with prism lenses and trained to use them for navigation and driving. Telephone interviews were used to obtain information about device usage 2 years following the completion of the training program. RESULTS: Patients' performance was compared with a test-retest criterion in the visual skills areas of recognition, mobility, peripheral detection, scanning, tracking, and visual memory. Patients with hemianopic loss showed improvements in all of the visual skills categories, ranging from the highest improvements of 26% of tasks improved in the mobility category to 13% in the recognition category. The majority of the hemianopic patients reported using the devices at the 2-year follow-up interview. CONCLUSIONS: The patients with homonymous hemianopsia showed improvements in visual functioning using prism lenses, although these improvements were smaller than those found in previous studies with central or bilateral peripheral vision loss groups who were trained to use other optical enhancement devices for navigation and driving using a similar curriculum. However, given the evidence of increased risk of accidents for patients with peripheral vision loss, the safety of peripheral enhancement devices for driving must be thoroughly evaluated before their impact on public safety is known.

Adult↗
PubMed2000

Should patients with psychogenic nonepileptic seizures be allowed to drive?

PURPOSE: To investigate the risk of driving accidents in patients with psychogenic nonepileptic seizures. METHODS: First, a survey was conducted in 82 physician-members of the American Epilepsy Society to determine what they recommend in patients with psychogenic seizures in regard to driving privileges. Second, we studied a population of 20 patients with proven psychogenic nonepileptic seizures diagnosed by prolonged EEG-video monitoring. We obtained the patients' driving records from the Wisconsin Department of Transportation. We used 1991 Wisconsin crash data as the reference year. We compared the expected number of motor vehicle crashes with the observed number of crashes. chi2 with Yates' correction for continuity was used to test for statistical significance. RESULTS: Of the 82 physicians questioned, 37 (45%) responded. Among respondents, the distribution was as follows: 49% applied the same restrictions as for patients with epilepsy; 32% did not place patients under any restrictions; and 19% decided on a case-by-case basis. The total number of reported crashes in the sample was eight, with no fatal crashes. This was not statistically significant (corrected chi2, 0.53) compared with the expected number of motor vehicle crashes for the sample. CONCLUSIONS: This small series does not support the use of driving restrictions for patients with psychogenic nonepileptic seizures.

Accidents, Traffic↗
PubMed1994

Sleepiness and ethanol effects on simulated driving.

Twelve healthy young men were assessed in each of four experimental conditions presented in a Latin Square design: 8-hr time in bed (TIB) and placebo, 4-hr TIB and placebo, 8-hr TIB and ethanol, and 4-hr TIB and ethanol. After consuming ethanol (0.6 g/kg) or placebo (0900-0930 hr) with 20% supplements at 1030 and 1100 hr, subjects were tested for sleepiness (Multiple Sleep Latency Test at 1000, 1200, 1400, and 1600 hr) and divided attention (1030 hr) performance on day 1, and for simulated driving and divided attention (1000-1200 and 1400-1600 hr) performance on day 2. In the morning testing, with breath ethanol concentrations (BECs) averaging 0.049%, sleepiness was increased, divided attention reaction times increased (on both days), and simulated driving performance was disturbed in the ethanol and 4-hr TIB relative to placebo. Similarly in the afternoon, with BECs averaging 0.013%, the ethanol and 4-hr TIB condition increased sleepiness and disrupted divided attention and simulated driving performance. The results show that sleepiness and low-dose ethanol combine to impair simulated automobile driving, an impairment that extends beyond the point at which BEC reaches zero. They provide a possible explanation for the incidence of alcohol-related automobile accidents at low BECs.

Adult↗
PubMed1990

Characteristics of an elderly driving population referred to a geriatric assessment center.

A retrospective, case-control study was performed to determine the characteristics of elderly drivers referred to an outpatient geriatric assessment center. It was hypothesized that the driving population was operating at a higher cognitive and functional level than nondrivers. One hundred eighty-two subjects meeting the entry criteria were studied. Twenty-three percent of the subjects were driving at the time of their assessment. Compared to nondrivers, drivers were younger (P = .0001), were more likely to be male (P = .003), scored higher on a mental status examination (P = .0001), and were more independent in Physical and Instrumental Activities of Daily Living (P less than .0001). Despite these findings, the mean Folstein Mini-Mental score for drivers (23.7) was below normal; 40% of drivers were diagnosed as having Alzheimer's dementia at the time of their evaluation, and over 26% of the drivers needed help with either dressing or bathing. The frequency of impaired elderly drivers in this referral setting was high. The authors conclude that conditions that affect the driving task are common in geriatric assessment centers. Prospective studies of elderly drivers are needed to answer the difficult question of who among the elderly should drive.

Activities of Daily Living↗
PubMed2000

The relationship between cognitive/neuropsychological factors and car driving performance in older adults.

OBJECTIVES: Because demographic changes produce a society with a growing number of older people, seniors constitute the fastest growing segment of car drivers. The objective of this research project was to identify cognitive factors related to driving problems in older adults. A top-down approach has been used, testing theory-driven hypotheses. DESIGN: Correlational study. SETTING: Fitness-to-Drive Assessment Centre of the Belgian Road Safety Institute. PARTICIPANTS: The research sample consisted of 84 car drivers aged over 65 years, who were referred for a general fitness-to-drive evaluation. MEASUREMENTS: The relations between seven specific neuropsychological tests and self-reported accidents were investigated. Furthermore, the relations between these same tests and a road test, independently assessed using a detailed evaluation grid, were analyzed in depth. These analyses were followed by stepwise multiple regression analyses. RESULTS: In a stepwise regression model, four neuropsychological tests could account for 64% of the variance of the score on the road test. Moreover, it could be demonstrated that specific cognitive subskills share common variance with specific real-world situations. However, neuropsychological tests could explain only 19% of the variance of self-reported at fault car accidents. CONCLUSIONS: The initial results of this study indicate the relevance of a cognitive/neuropsychological approach to the driving ability of older people. However, the link with accident risk seems more complex. Consequently, neuropsychological screening procedures are in need of a broader perspective to prevent an overemphasis on unidimensional screening procedures focusing mainly on deficit and less on capacities for safe behavior.

Accidents, Traffic↗
PubMed1986

Hypnotics and actual driving performance.

Several related studies of the residual effects of hypnotic drugs on actual driving performance have been conducted using a standard approach and the most recent is described in detail. In it, 12 female formerly diagnosed insomniacs and hypnotic users acted as subjects. They were treated in two separate series with placebo for 2 nights, then hypnotic medication for 8 nights followed by placebo again for 3 nights. In one series, the medication was nitrazepam (10 mg nocte) and in the other, temazepam (20 mg nocte). Eleven subjects completed both series in a double-blind, cross-over (with respect to drugs) design. Their driving performance was repeatedly tested on a 100 km primary highway circuit, in normal traffic, during both the morning and afternoon (10-11 hours and 16-17 hours after drug and placebo ingestion, respectively). Nitrazepam but not temazepam significantly impaired driving performance, the difference lasting throughout the active medication period. These results along with those obtained in the earlier studies are compared to show degrees of driving impairment which follow the use of various hypnotics.

Adult↗
PubMed1973

Direct arterial pressure and electrocardiogram during motor car driving.

Direct arterial pressure and electrocardiogram have been measured continuously over a period of 24 hours in 15 patients. Observations have been made on the behaviour of these variables during 30 separate episodes of motor car driving. The patients were divided into three groups: (1) five normotensive subjects, (2) five patients with essential hypertension who were not receiving therapy, and (3) five patients with angina pectoris who were either normotensive or hypertensive.In all but one subject, apart from variable changes in heart rate, no significant arrhythmias or S-T segment changes were observed in the electrocardiogram. The arterial pressure remained remarkably stable throughout the driving period in all three groups and there was no significant difference between the levels of blood pressure at the beginning and end of a journey. There were short periods of raised arterial pressure during driving related to such episodes as overtaking, but these quickly returned to baseline levels. Two patients experienced anginal pain during driving.It is concluded that motor car driving does not have such a pronounced effect on the blood pressure as might have been thought.

Adult↗