Gaseous oxygenation of the ischemic rat liver. The influence of driving pressure and oxygen concentration on tissue aeration.
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Adenosine↗
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Results for “Driving Under the Influence”
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[Driving under the influence of benzodiazepines. Sale differences in the counties are reflected among drivers suspected of driving under the influence of a drug].
This study was based on all blood samples taken from drivers suspected of being influenced by alcohol and or drugs and sent to the National Institute of Forensic Toxicology in 1992. Benzodiazepines were among the most frequently detected drugs. The ratio between samples containing benzodiazepines and the total number of samples was compared with the sales of benzodiazepines in the different Norwegian provinces. In 95% of the benzodiazepine positive samples, either a combination with other drugs or a concentration significantly higher than usually found after ordinary therapeutic use was observed. These results indicated that the fraction of samples positive on benzodiazepines probably representing drug abuse or misuse correlated with the total prescription of benzodiazepines in the different Norwegian provinces.
Alcohol Drinking↗
[Psychotropic drugs and automobile driving ability of elderly patients].
Many elderly patients are prescribed psychotropic medication, many of them are car drivers. Driving ability may be impaired by the underlying psychiatric disease, the medication or the combination of both. Psychoactive medications do not all influence driving ability to the same extent. Cyclic antidepressants impair driving performance to a higher degree than selective serotonin reuptake inhibitors (SSRI) or MAO inhibitors. In cases of severe psychiatric diseases like major depression an appropriate psychoactive medication may improve driving performance. The influence of psychoactive drugs on driving ability is not always taken into account. There are no data available that allow a reliable assessment of these drugs in elderly patients. To meet the challenge of this problem, patients and doctors have to be aware of this problem; studies about the impact of psychoactive drugs on driving ability are necessary.
Accidents, Traffic↗
Driving and dementia of the Alzheimer type: beliefs and cessation strategies among stakeholders.
PURPOSE: Although driving by persons with Alzheimer's disease (AD) is an important public health concern, we know little about the attitudes and perceptions of key stakeholders regarding driving safety in these individuals or the factors that precipitate and influence driving assessment and cessation decisions. DESIGN AND METHODS: We convened 10 focus groups composed of persons intimately involved in driving decisions for older adults to identify and compare beliefs and perceptions concerning AD and driving and to identify effective strategies to limit or cease unsafe driving. The 68 focus-group participants included health professionals, transportation and law-enforcement professionals, current and former drivers with AD, and family caregivers of current and former drivers with the disease. RESULTS: With few exceptions, participants said that a diagnosis of very mild AD alone did not preclude driving. Most regarded family members as pivotal in monitoring and managing unsafe driving and recognized their need for institutional and medical support, especially support from physicians in counseling and evaluation of health-related fitness of older drivers. Members of each group acknowledged their own roles and responsibilities in driving decisions and described difficulties they experienced in making assessments and implementing decisions to limit or stop the driving of given individuals with AD. IMPLICATIONS: Education of families, professionals, and transportation specialists is needed to understand the influence of AD severity on driving abilities, identify problem driving behaviors, make appropriate referrals of unsafe drivers, and access available resources for drivers with AD and those most responsible for their safety.
Accidents, Traffic↗
Crashes and violations among drivers with Alzheimer disease.
BACKGROUND: Several small studies have found a high automobile crash rate for drivers with Alzheimer disease (AD) compared with unaffected elderly drivers, prompting the suggestion that the diagnosis of AD mandate cessation of driving. OBJECTIVES: To compare automobile crash and violation rates of a large number of patients with AD with appropriately matched elderly subjects. To determine if neuropsychological test scores predict these adverse driving events. To determine if intervention by physicians or family members influences driving cessation. DESIGN: Review of crashes and violations from 1986 to 1993 in police-filed Michigan State driving records of 143 licensed patients with AD and 715 licensed comparison subjects matched 5 to 1 in age (+/- 6 years), sex, and county of residence. We correlated crashes and violations with neuropsychological test scores. A questionnaire-based inquiry on the influence of physician, family, and state interventions on driving cessation was administered. RESULTS: The crash and violation rates of patients with AD were not significantly different from those of comparison subjects. However, patients with AD probably drove fewer kilometers than did comparison subjects. Neuropsychological test scores did not predict future crashes or violations. CONCLUSIONS: This study, the largest to our knowledge involving state driving records of patients with AD, does not confirm the previously reported excessive crash rate among drivers with AD relative to an appropriate comparison population. Reduced driving exposure of patients with AD probably kept their crash adverse equal to that of comparison subjects. Intervention by physicians and family members was major factor in reducing driving exposure. These findings affirm that the mere diagnosis of AD does not justify license revocation.
Accidents, Traffic↗
An unusual case of driving under the influence of enflurane.
An unusual case of driving under the influence of the volatile anaesthetic enflurane is reported. A markedly affected anaesthetist was sniffing at an enflurane-moistened handkerchief before he crashed into a lorry at a red traffic light. In the blood sample enflurane (2.92 mg/l) as well as diclofenac (0.28 mg/l) and 4-aminophenazone (24.4 mg/l) were found. The way of driving and the accident and the deficiency symptoms could be explained by the central suppressing effects of enflurane. The physician was considered as impaired and not suitable to drive at the time of the incidence.
Accidents, Traffic↗
Legislated policies and recidivism for driving under the influence of liquor in Massachusetts.
Legislation on driving under the influence of liquor was changed significantly in Massachusetts on 1 December 1975; it permitted courts to continue cases without a finding if defendants were place probation and assigned to driver alcohol education. The effect of the revisions on the incidence of rearrest was assessed. The 3-yr arrest records of 522 individuals arrested for drunken driving 2 yr before the changes (1973) were compared with 716 and 690 offenders arrested 1 (1976) and 2 (1977) yr post-law modification. Sample participants were selected randomly. The legislation strongly affected court dispositions. Over 70% of the 1976-1977 cases were continued without findings and more offenders were sanctioned. The proportion found not guilty dropped from 1973 to 1976-1977. Absolute rearrest rates were similar for each cohort. Probability of arrest, however, rose substantially between 1973 and 1980. Relative to the increased arrest rate, there was a significant decline in rearrests 2 and 3 yr after a drunken driving arrest during the post-law period. The legislation apparently contributed to an amelioration of the drunken driving problem by encouraging judicial reforms and educational interventions.
Accidents, Traffic↗
Driving after cerebral ischemia--a driving simulator investigation.
UNLABELLED: Stroke patients with relevant deficits are not allowed to drive. This study tended to assess driving abilities in an early stage after cerebral ischemia with a driving simulator. METHODS: 32 patients (aged 54.9 +/- 14.8 years) with acute ischemia in the middle cerebral artery (MCA) (n = 24) and in the vertebral artery (VA) (n = 8) were investigated with reaction tests and a driving simulator. Controls were 12 healthy volunteers (aged 50.0 +/- 13.9 years). RESULTS: Compared to controls, the accident rate was increased only in patients with MCA-ischemia (2.9 +/- 3.6 vs. 1.3 +/- 1.4, p < 0.05). These patients also had poorer results in the driving simulator (p < 0.05) than patients with VA-ischemia. Driving simulator performance and neuropsychological test results did not correlate. CONCLUSION: All patients had only mild deficits and stated themselves able to drive. We could demonstrate the need to focus on driving skills especially in patients with MCA-infarctions. The driving simulator assesses various physical and neuropsychological functions influencing driving. It may especially be used for expert opinions regarding driving licence. It can also serve as a pre-driver evaluation before on road driving tests.
Accidents, Traffic↗
Usefulness of roadside urine drug screening in drivers suspected of driving under the influence of drugs (DUID).
In Belgium, the driving under the influence of drugs (DUID) procedure consists of three steps: observation of external signs of drug consumption by a police officer; an on-site urine test for amphetamines, cannabinoids, cocaine, and opiates; and blood sampling by a physician for gas chromatography-mass spectrometry analysis. The driver is sanctioned if THC is greater than 2 ng/mL, morphine is greater than 20 ng/mL, or amphetamine, methylenedioxymethamphetamine (MDMA), methylenedioxyethylamphetamine, N-methyl-1-(3.4-methylenedioxyphenyl)-2-butanamine, cocaine, or benzoylecgonine are greater than 50 ng/mL in plasma. We analyzed the results of 450 blood samples taken from May 2000 to February 2005. Cannabis was most often found above the cut-off (73.5% of the cases), followed by MDMA (20.4%), amphetamine (19.8%), benzoylecgonine (17.9%), cocaine (6.9%), and morphine (2.7%). One drug was found in 72.0% of the cases, two drugs in 22.6%, three drugs in 5.2%, and four drugs in 0.25%. In 10.7% of the plasma samples no target drugs were found above the legal cut-off. This percentage was 8.4% when urine was obtained and tested on-site and 21.2% when no urine was obtained (chi2 = 8.574, P = 0.0034). In 64.6% of these samples, a target drug (THC in 74.2%) was found under the legal cut-off. These data indicate that roadside urine testing significantly decreases the number of unnecessary blood analyses in DUID.
Automobile Driving↗
Driving tests with patients.
Mental illness and the use of psychotropic drugs are considered to influence driving skills of patients. However, studies which indicate the relative contributions of these factors are rare. It is emphasized that for measuring the effects of psychotropic drugs on driving performance of patients, real driving tests are needed. Actual driving and psychomotor performance of patients receiving diazepam, and patients and healthy volunteers receiving mebhydrolin were measured to illustrate the use of real driving tests. The results of both studies are discussed in terms of problems associated with the application of these tests. Patient recruitment is considered to be a major problem. To draw conclusions under these circumstances is extremely difficult, but still acceptable in comparison with the limitations and methodological difficulties of the more commonly used laboratory tests. Some guidelines for driving tests with patients are given.
Adult↗
Driving under the influence of chlormethiazole.
This article describes a case of driving under the influence of the sedative-hypnotic-anticonvulsant drug chlormethiazole. The suspect, who was a physician, was driving dangerously on a busy highway and caused a traffic collision. When apprehended by the police, the man had bloodshot and glazed eyes and pupil size was enlarged. He could not answer the questions properly and his gait was unsteady. A roadside breath-alcohol screening test was positive but an evidential breath-alcohol test conducted about one hour later was below the legal limit for driving of 0.10 mg/L (10 microg/100 mL or 0.021 g/210 L). Because of the special circumstances of the traffic crash and the man's appearance and behaviour, the police suspected that drugs other than alcohol were involved and obtained a venous blood sample for toxicological analysis. The blood contained 0.23 mg/g alcohol, which is above the legal limit for driving in Sweden 0.20 mg/g (20 mg/100 mL or 0.020 g/100 mL), and codeine was also present at a therapeutic concentration of 0.02 mg/L. The conflict between the clinical signs of impairment and the toxicology report prompted a reanalysis of the blood sample with major focus on sedative-hypnotic drugs. Analysis by capillary GC-NPD identified chlormethiazole at a concentration of 5mg/L, the highest so far encountered in traffic cases in Sweden. In 13 other impaired driving cases over 10 years the mean (median) and range of concentrations of chlormethiazole were 1.6 mg/L (1.6 mg/L) and 0.3-3.3 mg/L. This case report underscores the need to consider clinical observations and the person's behaviour in relation to the toxicology report when interpreting and testifying in drug-impaired driving cases.
Accidents, Traffic↗
Acculturation and driving under the influence: a study of repeat offenders.
OBJECTIVE: In California, driving under the influence (DUI) arrest and conviction rates are disproportionately higher among the Hispanic population. Acculturation and other factors associated with drinking and driving may help explain this disparity. METHOD: Interviews with Hispanic repeat DUI offenders were conducted immediately prior to sentencing and 2 years later. Arrest records from these offenders were also examined. Analyses were performed to examine the association between acculturation and other sociodemographic characteristics at baseline with DUI arrests and convictions at a 2-year follow-up. RESULTS: Logistic regression modeling showed that acculturation was significantly related to self-reported DUI recidivism even after controlling for other factors associated with DUI convictions during a 2-year follow-up. Acculturation was not found to have a statistically significant relation to DUI arrest rates during that same period. CONCLUSIONS: Among a Hispanic sample of repeat DUI offenders, the less-acculturated members were more likely to report a repeat DUI conviction at 2-year follow-up than the more-acculturated ones, even after controlling for other characteristics associated with DUI behaviors, such as drinking severity and marital status. The same pattern was not found between acculturation and arrest rates. Acculturation may serve as a risk factor for repeat convictions. Efforts to reduce multiple DUI convictions may need to consist of ways to target persons who are less acculturated.
Acculturation↗
Driving records of persons convicted of driving under the influence of alcohol.
The average interval between convictions of driving under the influence decreases from 2 years between first and second convictions to 17, 11 and 8 months, respectively, between the second and third, the third and fourth and the fourth and fifth convictions.
Accidents, Traffic↗
Hispanics, Blacks and White driving under the influence of alcohol: results from the 1995 National Alcohol Survey.
OBJECTIVE: To report nationwide survey data on patterns of driving under the influence of alcohol among Whites, Blacks and Hispanics. METHOD: Data were obtained from a probability sample consisting of 1582 Blacks, 1585 Hispanics and 1636 Whites in the US household population. Interviews averaging 1 h in length were conducted in respondents' homes by trained interviewers. RESULTS: Self-reported rates of driving a car after having drunk enough 'to be in trouble if stopped by the police' were highest among White and Hispanic men (22 and 21%, respectively), as were lifetime arrest rates for driving under the influence of alcohol (13% for White men, 19% for Hispanic men). Additionally, our analyses suggest that drinkers who drive under the influence of alcohol are more likely to be men (regardless of ethnicity), consume more alcohol, and be alcohol dependent than drinkers who do not engage in alcohol-impaired driving.
Adult↗
Driving patterns and medical conditions in older women.
OBJECTIVES: To describe driving patterns (e.g., driving frequency) in older women drivers and to evaluate the impact of medical conditions and comorbidity on driving patterns. DESIGN: Cross-sectional examination of the association between medical conditions and driving patterns. SETTING: Population-based cohort from the Pittsburgh Center of the Study of Osteoporotic Fractures (SOF). PARTICIPANTS: A total of 1768 women aged 71 years or older. MAIN MEASUREMENTS: Driving information was obtained through a driving questionnaire, including driving status, weekly mileage, longest trip in the past year, etc. Data for demographics, lifestyle behavior, and medical conditions were collected through the SOF study. RESULTS: Among the participants, 1103 (62.3%) were current drivers, 337 (19.1%) had stopped driving, and 329 (18.6%) had never driven in their lifetime. The proportion reporting driving cessation and decline in driving amount increased with age. The prevalence of most medical conditions was higher among former drivers than in current or never drivers. Even after controlling for age and other demographic variables, fractures, heart disease, diabetes, self-reported poor vision or hearing, as well as comorbidity were found to be associated independently with decreased driving amount, including driving cessation, decline in mileage, and avoiding long trips. CONCLUSION: Both individual medical conditions and comorbidity influence driving patterns in older drivers. Because it is common for older people to have several medical conditions simultaneously, comorbidity might be a more comprehensive measure of medical impact on driving.
Activities of Daily Living↗
Cognitive, sensory and physical factors enabling driving safety in older adults.
We reviewed literature on cognitive, sensory, motor and physical factors associated with safe driving and crash risk in older adults with the goal of developing a model of factors enabling safe driving behaviour. Thirteen empirical studies reporting associations between cognitive, sensory, motor and physical factors and either self-reported crashes, state crash records or on-road driving measures were identified. Measures of attention, reaction time, memory, executive function, mental status, visual function, and physical function variables were associated with driving outcome measures. Self-monitoring was also identified as a factor that may moderate observed effects by influencing driving behavior. We propose that three enabling factors (cognition, sensory function and physical function/medical conditions) predict driving ability, but that accurate self-monitoring of these enabling factors is required for safe driving behaviour.
Accidents, Traffic↗
Mortality among subjects previously apprehended for driving under the influence of traffic-hazardous medicinal drugs.
BACKGROUND: Most studies in the field of impaired driving have focused on the hazards represented by impaired drivers to the rest of society; there has been little follow-up of the drivers themselves. The aim of this study was to establish mortality rates among subjects previously apprehended for driving under the influence of traffic-hazardous medicinal drugs, alone or in combination with alcohol. METHODS: A prospective cohort study of all drivers aged 20-49 years, apprehended in Norway in 1992-1996 and testing positive for traffic-hazardous medicinal drugs in blood, outcome variable: death. STUDY POPULATION: 805 drivers (598 males, 207 females). Mean follow-up period: 6.8 years. Information on deaths was collected from Statistics Norway. RESULTS: During the follow-up period, 139 of the previously apprehended drivers died (110 males, 29 females). The calculated standardised mortality ratio (SMR) was 15.8 (95% CI: 13.0-19.0) for male and 20.0 (95% CI: 13.4-28.7) for female drivers. CONCLUSIONS: Apprehension on suspicion of driving under the influence of drugs, combined with detection of traffic-hazardous medicinal drugs in the blood, seems to indicate an elevated risk of premature death in the age group 20-49 years. Secondary prevention of continued drug use could save lives in this drug user group.
Adult↗
Arrests of women for driving under the influence.
Police records of arrests of women in Wichita, Kansas for driving under the influence (DUI) of alcohol for a 5-year period (1980-1984) were studied. The proportion of arrests of women increased from 10.6 to 14.5% of total arrested. Women in their 20s comprised the largest age group; single women were greatly overrepresented. More than one-half of the arrested women were employed outside the home; a substantial proportion (30.8%) were unemployed at the time of arrest. The average blood alcohol level of those tested was 183 mg/dl. Characteristics of arrestees are discussed in terms of changes in the social roles and expectations of women. Although time of arrest was similar to that of men (i.e., night), arrests of women were more evenly spread across the days of the week. Within the 5-year period, the rate of recidivism for DUI was 7.43%. The implications of arrest and recidivism patterns are discussed. A change in legal and arrest procedures was found to have the same effect on arrests of women as it had on those of men, suggesting that the changes did not produce differential treatment by police.
Adolescent↗