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PubMed2006

[Fundamental study of turbo spin echo sequence with driven equilibrium pulse].

UNLABELLED: When MR images are obtained with the turbo spin echo (TSE) sequence, DRIVE can be used as a sequence in which the driven equilibrium pulse (DE pulse), a reset pulse, is applied at the TSE echo train to accelerate relaxation time and return to the equilibrium of Mz magnetization. In this study, we examined the extent to which TR could be shortened in DRIVE and how the other parameters of the turbo spin echo sequence influence it. RESULTS: 1) DRIVE is effective when the T2 value is long. 2) It is necessary to set TR at 1000 ms or more to obtain image contrast with free water and fat in T2-weighted images for which a conventional turbo spin echo sequence using DRIVE is employed in clinical examination. 3) It is not necessary to consider the influence of the TSE factor when using DRIVE.

Echo-Planar Imaging↗

PubMed1993

[Determination of limit values for "safe driving" in street traffic with reference to centrally active drugs from the pharmacokinetic and pharmacodynamic viewpoint].

When establishing threshold values for "driving under the influence of centrally acting compounds" it must be considered that many parameters have an important influence on the pharmacokinetic properties (e.g. volume of distribution, the elimination half-life, and the drug concentration in body fluids) and the pharmacodynamic action (e.g. impairment of skills related to driving). This article describes these inter-and intraindividual parameters from the pharmacokinetic (influence of body weight, age, gender, genetics, diseases, other compounds as ethanol and antacids, enzyme induction, enzyme inhibition, first-pass effects, pharmacokinetic interaction, chronopharmacokinetics, mode of application) and pharmacodynamic (tolerance, pharmacodynamic interaction, pharmacogenetic, chronopharmacodynamic, pathological alterations) point of view. The large variabilities clearly indicate, that preliminary threshold values should be chosen high enough to prevent prejudice of traffic participants. A "consensus value" could be established and continuously monitored by a commission. Beside this the high relevance of valid analytical investigations must be regarded.

Adult↗

PubMed1992

Accidents in the north. Some aspects on snowmobile accidents and moose-car collisions.

Snowmobile accidents and moose-car crashes are typical accidents in Northern Sweden. In this region there is about 1 snowmobile/10 inhabitants. The present paper combines previously published studies. The studies on snowmobile accidents are based on a material comprising all 61 fatally injured snowmobile drivers from the four northern counties of Sweden during the period 1973-1987. The helmet usage was analyzed in two clinical study populations including 200 injured from the county of Västerbotten from two periods 1979-1980 and 1985-86. Of the fatally injured (median age 32 years) 86% were driving under the influence of alcohol with a mean blood alcohol concentration of 0.17 g/ml. Serious head injuries were uncommon among persons driving without a helmet in the clinical material. Only in about 6% of the cases an open face helmet would probably have had an injury reducing effect. Drunken driving is an important etiological factor for fatal snowmobile accidents. Preventive measures must include information that the Traffic Temperance Law also applies to snowmobile riding. A helmet law for snowmobile riders does not seem to be motivated from the injury reduction point of view. According to official Swedish police statistics more than 400 car occupants are injured annually in crashes with a moose. The crash mechanism is special. Because of its long legs the body of the moose hits directly against the windshield, windshield pillars and front roof. During a period of three years 154 injured passenger car occupants were treated in the hospitals in Umeå and Skellefteå. Of both the front and rear seat occupants 80% suffered laceration injuries from glass or glass splinters.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Traffic↗

PubMed1978

[Occurrence of diazepam in blood samples of drivers under the influence of alcohol (author's transl)].

Diazepam was determined by radioimmunoassay and gas chromatography in 2050 unselected blood or serum specimens of subjects, who were sus,ected of driving under the influence of alcohol in the years 1974 and 1976. A "cut-off" limit of 20 ng/ml was selected. Diazepam was found in 46 samples corresponding to 2.24%, 27 samples (1.3%) exhibited concentrations of 20--100 ng/ml, 14 samples (0.7%) of 100--500 ng/ml, 1 sample (0.05%) of 500--1000 ng/ml and 4 samples (0.2%, as related to the total of 2050 samples) of more than 1000 ng/ml. Furthermore, 44 blood specimens of subjects were analyzed, who had claimed diazepam intake before the blood sample was withdrawn. Diazepam was found in 27 cases corresponding to 61%. Finally, blood specimens of 219 unselected inpatients of a surgical ward were investigated; 59 of these (27%) were found to be diazepam-positive.

Alcoholic Intoxication↗

PubMed2000

Assessment of university students' coping strategies and reasons for driving in high-risk drinking-driving situations.

A total of 116 students (87 women; 29 men) enrolled at a large, public Midwestern university in the United States were recruited to complete a set of demographic questionnaires and drinking-driving episode surveys. The latter surveys assessed participants' reported motivations for driving or not driving during four recent drinking episodes. Content analyses were used to develop lists of commonly reported reasons for not driving (e.g. found alternate transportation), reasons for driving after drinking (e.g. perceived need to go to destination), potential alternatives to driving after drinking (e.g. walking to destination), and strategies used to avoid detection or arrest by police (e.g. driving more slowly, using back roads or side streets). Participants made both situational and self-coping attributions to explain why they did not, on occasion, drive after drinking. These results may be used as a foundation for prevention and education programs that are designed to: (a) encourage use of coping strategies and alternatives to driving while disputing peer-generated justifications for driving after drinking, and (b) challenge the value of potentially unsafe strategies for avoiding detection and arrest when driving under the influence.

Accidents, Traffic↗

PubMed1997

Drugged driving, a review based on the experience in Norway.

Since 1959, the Norwegian Road Traffic Act has prohibited driving under the influence of drugs other than alcohol. On suspicion, the police request a clinical examination from any driver, as well as blood analyses for illegal and prescribed drugs affecting driving performance. During the last few years, there has been a marked increase in the number of drivers suspected of be influenced by drugs (1983, n = 900; 1995, n = 3329). The most commonly detected drugs are tetrahydrocannabinol, amphetamine, benzodiazepines and opiates. Multi-drug use is frequently found (> 60%). The occurrence of amphetamine (1991, n = 216; 1995, n = 937) and heroin (1991, n = 19; 1995, n = 172) has increased considerably. The frequency of drugged drivers apprehended in roadside traffic appears to be at least 10-fold higher in Norway than most other countries. This is probably mainly due to differences between national road traffic acts and the level of attention to the problem, and not to national differences in the prevalence of drugged driving.

Accidents, Traffic↗

PubMed1985

Diabetes, driving, and the general practitioner.

The medical fitness of drivers who have diabetes is assessed primarily by general practitioners. A survey was made of the knowledge of driving and diabetes of 105 general practitioners in Glasgow. Ninety four (90%) knew that people who were insulin dependent were required by law to declare their condition to the Driver and Vehicle Licensing Centre in Swansea, but most were unaware that people with diabetes should not hold a "till 70" driving licence. Seventy one doctors (69%) claimed that patients were recalled individually for fitness to drive. The minimum visual acuity for driving was stated correctly by 37 (35%). Only eight respondents knew that a hypoglycaemic diabetic driver can be charged with driving under the influence of a drug (Road Traffic Act 1972), and the practical advice that was given to patients about hypoglycaemia and driving was unsatisfactory. As a group the general practitioners showed deficiencies in knowledge regarding diabetes and driving, suggesting a need for further postgraduate education.

Automobile Driving↗

PubMed1992

A modeling analysis of young drivers' judgments of accident risk due to alcohol use and other driving conditions.

Male (60) and female (60) college students who were under the legal drinking age completed a personal driving experience questionnaire and judged the probability of an accident occurring in 100 driving scenarios, half involving an intoxicated male driver and half a sober male driver. The scenarios also varied in terms of the safety levels of five other driving factors. Mathematical models derived from the probability judgments permitted measurement of the influence of the various driving factors on perceived risk. The driving factors in order of their influence on the accident probability judgments were driver intoxication-nonintoxication, vehicle speed, road conditions, driver mood and driving experience, which did not significantly differ, and the driver's experience with alcohol use. Accident probability estimates of the alcohol scenarios increased as an additive function of the other driving factors, whereas increased risk of an accident in the no-alcohol scenarios was more dependent upon multiple unsafe factors. Female students judged the probability of an accident higher overall than did male students. Subject drinking classification (abstain-light, moderate or heavy) was not related to accident probability estimates.

Accidents, Traffic↗

PubMed1994

Testing reckless drivers for cocaine and marijuana.

BACKGROUND: Driving under the influence of intoxicating drugs other than alcohol may be an important cause of traffic injuries. We used a rapid urine test to identify reckless drivers who were under the influence of cocaine or marijuana. METHODS: We conducted a consecutive-sample study in Memphis, Tennessee, in the summer of 1993. Subjects arrested for reckless driving who were not apparently impaired by alcohol (did not have an odor of alcohol, tested negative on breath analysis, or both) were tested for cocaine and marijuana at the scene of arrest. The results of the drug tests were compared with clinical evaluations of intoxication made at the scene by a police officer. RESULTS: A total of 175 subjects were stopped for reckless driving, and 150 (86 percent) submitted urine samples for drug testing at the scene of arrest. Eighty-eight of the 150 (59 percent) tested positive: 20 (13 percent) for cocaine, 50 (33 percent) for marijuana, and 18 (12 percent) for both drugs. Ninety-four of the 150 tested drivers were clinically considered to be intoxicated, and 80 of them (85 percent) tested positive for cocaine or marijuana. The intoxicated drivers had a broad range of affects and appearances. Nearly half the drivers intoxicated with cocaine performed normally on standard sobriety tests. CONCLUSIONS: Over half of the reckless drivers who were not intoxicated with alcohol were found to be intoxicated with other drugs. Toxicologic testing at the scene is a practical means of identifying drivers under the influence of drugs and is a useful adjunct to standard behavioral sobriety testing.

Adult↗

PubMed2006

Relationship between THC concentration in blood and impairment in apprehended drivers.

OBJECTIVE: The most important psychoactive ingredient in cannabis, Delta (9)-tetrahydrocannabinol (THC) is one of the most frequently detected substances in blood samples from suspected impaired drivers in Norway. There is growing concern over possible links between the use of cannabis and increased risk of motor-vehicle crashes. Experimental studies have provided useful information on the role of THC and dose-effect relations with respect to psychomotor performance. The main purpose of the present study was to investigate whether a physician's judgment on impairment in a real-life setting among suspected drugged drivers, was related to blood THC concentration. METHODS: In Norway a police physician performs a clinical test for impairment (CTI) shortly after apprehension. The Norwegian Institute of Public Health analyze blood samples from all drivers suspected of driving under the influence of non-alcoholic drugs. In the present study 589 samples from approximately 30,000 cases of suspected drug impaired driving from the period 1997-99, contained THC as the only drug. In 456 of these cases a conclusion of the CTI was available. RESULTS: 230 (54%) drivers were considered not impaired and 226 (46%) impaired. Impaired drivers had higher blood THC concentration than the drivers who were judged as not impaired (median; 2.5 ng/mL (range; 0.3-45.3 ng/mL) vs 1.9 ng/mL (range; 0.32-24.8 ng/mL), (p < 0.05). Furthermore, drivers with blood THC concentrations above 3 ng/mL had an increased risk for being judged impaired compared to drivers with lower concentration ranges. CONCLUSION: The relationship between the concentration of THC in blood and risk of being assessed impaired found in this cross-sectional study of suspected drugged drivers, supports findings from previous experimental studies of concentration related effects of THC on psychomotor performance and driving skills.

Accidents, Traffic↗

PubMed1989

[Effects of the nutritional status on the respiratory system].

Mechanically ventilated patients are at high risk for malnutrition, and it is now accepted that nutrition can influence the respiratory function. In particular, malnutrition can adversely affect lung function and the adverse effects of such malnutrition include: decreased ventilatory drive, decreased respiratory muscle function, alterations of lung parenchyma and depressed lung defense mechanisms. Therefore, nutrition support should be considered if a patients has a severe chronic pulmonary disease or an acute respiratory disease. Recent studies showed that malnourished patients have a reduced respiratory muscle strength and that nutritional intervention can return muscle ventilatory function to normal levels. Furthermore, it seems very likely that the ventilatory drive can be influenced by dietary intake of amino acids and glucose. The structure of the pulmonary parenchyma can be affected by starvation and the pulmonary defense mechanisms are depressed in malnourished patients. The incidence of post-operative pneumonia or atelectasis is higher in protein-depleted patients. in comparison with well-nourished patients. In conclusion, the importance of nutrition support in the management of patients with respiratory failure, particularly those mechanically ventilated, is stressed in the paper.

Humans↗

PubMed1984

Simulated car driving as a useful technique for the determination of residual effects and alcohol interaction after short- and long-acting benzodiazepines.

SUBJECTS AND METHODS: 54 healthy volunteers took part in 3 placebo controlled double-blind trials designed partly as crossover, partly as parallel group studies. The long-acting (elimination half-life greater than 24 h) test drugs diazepam (DIA 5; 10 mg) and flurazepam (FLU 30 mg) were compared to the short-acting drugs (elimination half-life less than 12 h) lormetazepam (LOR 1.5; 2 mg) and mepindolol sulfate (MEP 10 mg; betablocker) following acute or subchronic application. Alcohol (ALC; 0.4-0.8 per mill blood ALC concentration) was used as a compound interfering with the test drugs. Measurements with the driving simulator TS2 were taken at different times between 1 h and 15 h p.a. RESULTS: Subchronic use of FLU causes significant impairment of driving performance the next morning in contrast to LOR which even increases the driving ability. The ALC potentiating effect of LOR is larger than that of DIA after acute intake. MEP acts like placebo but reduces blood pressure and heart rate. Interaction of LOR and ALC in the evening does not result in a prolonged hangover effect which could disturb driving performance the next morning. DISCUSSION: Short-acting benzodiazepines without active metabolites have a profound advantage over those with long-acting accumulating characteristics in respect to matutinal car driving ability, if those drugs are used as nighttime hypnotics. These results highlight the necessity of screening hypnotic and tranquilizing drugs concerning their influence on car driving performance at different times after intake and under conditions of interactions with psychotropic drugs, especially alcohol. In view of future methodological requirements a revised model of driving simulation is presented. It is based on a coherent description of the system "driver-vehicle environment" at the level of visual conditions, vehicle behaviour and driver performance. Preliminary data are shown.

Anti-Anxiety Agents↗

PubMedDate not supplied

Personality traits and behaviors of alcohol-impaired drivers: a comparison of first and multiple offenders.

Using an interview and questionnaire format, 358 driving under the influence of alcohol (DUI) first offenders and 141 DUI multiple offenders were compared on measures of personality traits, drinking behavior and problems, and driving behavior and history. In addition, official driving records for the two groups were compared. Results indicated that multiple offenders were significantly higher in hostility, sensation seeking, psychopathic deviance, mania, and depression than first offenders. Multiple offenders were significantly lower in emotional adjustment and assertiveness. Multiple offenders had significantly more nontraffic arrests, accidents, and traffic tickets than first offenders. They also consumed significantly more alcohol, evidenced more alcohol problems, and had higher BACs at the time of arrest than first offenders. Results are discussed in terms of general problem behavior and implications for intervention and treatment.

Accidents, Traffic↗

PubMed2003

Association of main driver-dependent risk factors with the risk of causing a vehicle collision in Spain, 1990-1999.

PURPOSE: To assess the strength of association of main driver-dependent risk factors with the risk of causing a collision between vehicles in Spain, from 1990 to 1999. METHODS: The data for this paired-by-collision, case-control study were obtained from the Spanish Dirección General de Tráfico traffic crash database. The study included all 220284 collisions involving two or more vehicles with four or more wheels, in which only one of the drivers involved committed an infraction. Infractor drivers comprised the case group; noninfractor drivers involved in the same collision were their corresponding paired controls. RESULTS: All driver-dependent factors were associated with the risk of causing a collision. The highest adjusted odds ratio estimates were obtained for sleepiness (64.35; CI, 45.12-91.79), inappropriate speed (28.33; CI, 26.37-30.44), and driving under the influence of alcohol with a positive breath test (22.32; CI, 19.64-25.37). An increase in the number of years in possession of a driving license showed a protective effect, albeit the strength of the effect decreased as age increased. CONCLUSIONS: Our results emphasize the urgent need to implement strategies aimed mainly at controlling speeding, sleepiness, and alcohol consumption before driving-the main driver-dependent risk factors for causing a vehicle collision.

Accidents, Traffic↗

PubMed1998

Perceived organizational support and police performance: the moderating influence of socioemotional needs.

Police patrol officers were surveyed to investigate how the strength of socioemotional needs affects the relationship between perceived organizational support (POS) and work performance. The association of POS with driving-under-the-influence arrests and speeding citations generally increased with strength of the needs for esteem, affiliation, emotional support, and social approval. Patrol officers with strong socioemotional needs, but not those with weak needs, showed a positive relationship between POS and performance. The findings are consistent with social exchange views that maintain (a) work effort is encouraged by the receipt of socioemotional resources, (b) POS fulfills a variety of socioemotional needs, and (c) the value of POS and the obligation to reciprocate with high performance increase with the strength of socioemotional needs.

Adult↗

PubMed1999

The perception of safe driving ability during hypoglycemia in patients with type 1 diabetes mellitus.

PURPOSE: Insulin-induced hypoglycemia and its sequelae of cognitive impairment may place patients with type 1 diabetes at risk when driving and when making decisions about driving. Little is known about the factors that influence judgments of safe driving ability during hypoglycemia in these patients. PATIENTS AND METHODS: Thirty men and 30 women with uncomplicated type 1 diabetes (age [mean +/- SD] 33 +/- 9 years, duration 9 +/- 3 years, hemoglobin A1c level 8.7% +/- 1.0%) underwent a stepped hypoglycemic insulin clamp. Serum glucose levels were reduced from 120 mg/dL to 80, 70, 60, 50, and then 40 mg/dL during 190 minutes. At each glucose plateau, patients completed a symptom questionnaire and neuropsychological test, estimated their glucose level, and reported whether they could drive safely. RESULTS: The proportion of patients judging that they could drive safely decreased as serum glucose levels decreased from 70% at 120 mg/dL to 22% at 40 mg/dL. Men and middle-aged patients were more likely to consider it safe to drive during hypoglycemia than women and those under 25 years of age. Those who were symptomatic and those who recognized hypoglycemia were less likely to report safe driving ability during hypoglycemia. Most patients who were cognitively impaired appeared to recognize this and reported that they could not drive safely at a serum glucose level of 40 mg/dL. CONCLUSIONS: Adults with type 1 diabetes need educational reinforcement of safe driving habits, particularly to check glucose levels before driving. Glucose levels less than 70 mg/dL should be treated before driving. This information is as important for middle-aged, experienced drivers as it is for younger, inexperienced drivers.

Adult↗

PubMed1997

[Driver's license expertise and psychiatric diagnosis. An analysis of 712 specialist expert assessments].

In a large University Department of Psychiatry a retrospective analysis of 712 psychiatric expertises on fitness to drive was carried out to identify factors influencing the decision "unfit to drive". Psychological test results were identified as the most potent factors influencing this decision, whereas a psychiatric diagnosis seems to be less important. The results indicate that demographic data and history (previous psychiatric hospitalisations, previous verdict "unfit to drive") were not influential. It is concluded that today's psychiatrists, when carrying out expertises on the question of fitness to drive, do not follow previous recommendations of placing a verdict of "unfit to drive" on all persons with a psychiatric diagnosis. They obviously follow a more individualised and pragmatic approach.

Alcoholism↗

PubMedDate not supplied

The adrenergic-cholinergic imbalance hypothesis of depression: a review and a perspective.

The catecholamine deficiency hypothesis of depression was essentially based on the incidental detection of iproniazide and imipramine. However, current findings favor noradrenergic overactivity, at least in the periphery. The incidental observation of acute behavioral inhibition by centrally active cholinomimetics like physostigmine suggested a cholinergic-adrenergic balance involved in the regulation of drive and mood. Indeed, cholinomimetics seem to have acute depressiogenic and antimanic properties and, conversely, anticholinergics some acute euphoriant activity. However, time course and dose-response relationships of drugs influencing mood and drive do not favor simple concepts of too much or too little activity of one or the other transmitter system. Cholinomimetics and psychostimulants show an acute mutual antagonism, the mechanism of which is obscure. In healthy volunteers clonidine and the putative antidepressant brofaromine did not influence the effects of physostigmine. Patients with mood disorders respond supersensitively to a cholinergic challenge in terms of behavior, neuroendocrine regulation and REM sleep induction. Thus, the anticholinergic properties of tricyclics might be relevant to their antidepressant activity. However, adjunctive treatment with the cholinolytic biperiden as compared to placebo did not enhance the antidepressant efficacy of mianserin or viloxazine. This is incompatible with cholinergic overactivity contributing to the depressive state. Physostigmine induces autonomous and endocrine responses reminiscent of stress reactions. Findings in healthy volunteers suggest relationships between the sensitivity to physostigmine and personality traits like irritability and emotional lability and passive stress coping strategies. Thus, the cholinergic supersensitivity in mood disorders might be related to some personality dimension like stress intolerance rather than the depressive state itself.

Acetylcholine↗