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PubMed2005

[Treatment of adult patients with epilepsy in the children's hospital].

During one year from November 2002 to October 2003, 810 patients with epilepsy were examined in Shiga Medical Center for Children, and 186 patients (23%) were over 18 years old. Among them, 162 adult patients (male; 52%, female; 48%) were regularly examined at the outpatient-clinic. Seizures persisted in 56% of these adult patients. Over 80% of the patients were classified as symptomatic epilepsy. Seventy-eight percent of the cases were combined with physical or mental disability. Six percent of the patients had psychological disorders and 11% of the patients had internal diseases. Fifteen percent of the patients had jobs, 4% were married, and 8% had driver's licenses. Seventy percent of the patients were not independent because of their handicap. In our children's hospital, adult patients with epilepsy are increasing, and a countermeasure is necessary. It is important to join networks between regional adult hospitals and clinics. On the other hand, pediatric neurologists must study psychological and internal diseases, management of women with epilepsy, and employment and driving in patients with epilepsy.

Adolescent↗
PubMed1998

[Evaluating driving ability after brain damage. Neuropsychological diagnosis and driving test].

The study examined the validity of psychometric measures for the assessment of driving ability in brain-damaged subjects. 116 patients with brain damage mainly of vascular and traumatic origin underwent extensive neuropsychological examinations emphasizing attentional performance and visual perceptual speed and participated in a comprehensive on-road driving test. Only 58% of the patients passed the driving test. Attempts to predict the outcome of the driving test by discriminant analysis or cut-off procedures based on neuropsychological and/or other subject-related data yielded a maximum of 73% correct predictions. In view of the frequent impairment in driving ability after brain damage and in view of the failure to reliably predict driving ability from psychometric test results, it is recommended that in each case an on-road driving test is given.

Adult↗
PubMed2001

[Assessment of car driving skills in brain injured individuals].

Independent driving is considered as very important for a full independence and social integration of disabled people. In these patient with disabilities or handicaps, the driving skills must be carefully assessed, especially in presence of a moderate dysexecutive syndrome. A precise neurological and neuropsychological examination is usually necessary to evaluate aptitudes for driving. Standard neuropsychological tests are often limited to value the brain injury patients. At the moment, assessment on driving simulators really improves the opinion of medical experts, as they give qualitative and quantitative data on reproducible conditions. In fact, in more than 80% of cases, the tests on driving simulators allow to determine if the patient is able to drive or no, with or without a specially adapted vehicle. However, in a small percentage of cases, the evaluation of open-road driving by a driving instructor is necessary, proving that driving simulators will never take over from reality.

Automobile Driver Examination↗
PubMed2006

Gender differences in the Swedish driving-license test.

INTRODUCTION: Male drivers between 18-24 years are involved in many more motor-vehicle accidents than female drivers in Sweden. Is there also a gender difference in test performance in the Swedish driving-license tests? Is it a real difference or do any of the items display differential item functioning (DIF) with respect to gender or educational background? METHOD: Two random samples of test-takers' performance on the Swedish theory driving-license test were examined with descriptive and inference statistics. RESULTS: Female test-takers performed better than male test-takers on the theory test, which is a real difference since no items displayed DIF with respect to gender. There was no gender difference in the practical test. The gender difference in the theory test could not be fully explained by differences in educational background. CONCLUSIONS: Although everyone who passes the driving-license test has fulfilled the goals stated in the curriculum, it is possible that the gender differences in the theory test are consistent over time, and therefore might be one factor that explains why male drivers are over-represented in traffic accidents. IMPACT ON INDUSTRY: Gender differences appear persistent over time. Therefore, by improving male test takers' result on the test may lead to positive effects on the male test takers future driving career.

Accidents, Traffic↗
PubMed2005

An exploratory study on the predictive elements of passing on-the-road tests for disabled persons.

OBJECTIVES: Driving evaluations are performed by Occupational Therapists to evaluate drivers with disability. They include both off-road and on-road assessments. Many aspects of driving are examined during the on-road assessment. The main objective of this study is to identify the elements of the Occupational Therapy on-road driving assessment that are most predictive of the overall driving evaluation. METHODS: This retrospective cohort study took place at a provincially approved Driving Assessment Program. Records of 700 participants with various disabilities who completed a driving assessment between 1995 and 2003 were reviewed. Only clients who completed the on-road assessment were included in the study. At our center, 11 driving elements comprised of 34 items were used as independent variables and rated as pass (acceptable or good) or fail (borderline or poor). Analysis was completed with descriptive statistics and use of logistic regression to identify elements that contributed most significantly to the overall driving evaluation. RESULTS: A total of 628 clients completed the on-road assessment with an overall pass rate of 50%. Logistic regression modeling identified poor anticipation of road hazards, observation of environment, improper stopping position, poor visual scanning, poor knowledge of the rules of the road, and increasing age as predictive of failure for all participants. Further analysis grouped subjects according to disability to identify similarities and differences between pass/fail predictors. Both similarities and differences in predictive elements were found between cognitive and physical diagnostic groupings. Most notably, the physical diagnostic grouping showed that cognitive, not physical elements of the on-road test, predicted failure of the overall driving evaluation. CONCLUSIONS: Of the 11 elements considered in the on-road evaluation, specific cognitive ones such as anticipates potential hazards, scanning, observes for pedestrians, and proper stopping position tend to contribute more to the prediction of pass or fail than others. These elements should be considered as components of on-road assessments by other Driving Assessment Programs.

Adult↗
PubMed2000

[Are physicians' examinations required for driving licences correct?].

73 consecutive medical certificates for granting driving licenses were examined. The certificates were given on standard forms with yes/no tick boxes. They were used by the Norwegian Board of Health in handling appeals against rejected applications for exemption from the health requirements for driving licenses. Two of the 73 certificates contained incorrect statements about the applicants' medical conditions. A further two were incomplete with regard to medical facts known to the issuing physician, whereas the remaining 69 certificates gave correct information about the health of the applicant. The conclusion as to whether the applicant fulfilled the health requirements was correctly stated in 30 certificates (41%). 22 certificates (30%) wrongly concluded that the requirements were met, and 21 (29%) lacked a conclusion. The health requirements are printed on the certificate form along with a note to remind the physician to adhere to them. We conclude that even in official medical certificates with yes/no tick boxes, physicians may be reluctant to give conclusions they understand will not benefit their patients.

Automobile Driver Examination↗
PubMed2005

Vision requirements for driver's license examiners.

PURPOSE: The purpose of this study was to determine the vision requirements for licensing and registration examiners (LREs) of motor vehicle drivers in the state of California. METHODS: A comprehensive investigation was conducted that included a literature review, consideration of the Americans with Disabilities Act, analysis of materials with a subject matter expert panel, an overview of visual function tests, a formal job analysis, job audits and site visits to licensing offices, analysis of accidents and critical incidents, performance of simulation studies, and a review and evaluation of all materials collected during the study. RESULTS: Based on this analysis, three visual functions (best-corrected visual acuity, peripheral visual field extent, and color vision) were determined to be important for performing the essential job functions of an LRE. It was recommended that LREs demonstrate a best-corrected visual acuity of at least 20/20 in each eye, a peripheral visual field of at least 100 degrees diameter of horizontal and vertical extent in each eye (with no evidence of scotomas or pathologic areas of nonseeing within the visual field), and color vision capabilities that permit a passing score on the Farnsworth Panel D-15 color vision test. DISCUSSION: The findings of this investigation provide a strong basis for specifying and justifying vision requirements for performing essential job functions for an LRE in the state of California.

Adult↗
PubMed1998

[Drunken driver examinations. CD-transferrin is a valuable marker of alcohol consumption].

The article reports findings in a study of 198 subjects attending a psychiatric out-patient clinic, with known or suspected high alcohol consumption during a 12-month period, about half of whom had had their driving licences revoked. The level of carbohydrate-deficient transferrin (CDT) was found to be a valuable marker of alcohol consumption, and a useful adjunct to the measurement of liver enzymes. Both GGT (gamma-glutamyltransferase) and CDT levels were significantly higher in high alcohol consumers than in low consumers. Alcohol the two markers did not differ from each other in statistical significance, CDT was associated with greater sensitivity and specificity; the sensitivity of CDT was 69% for men and 79% for women, as compared with 62% and 40%, respectively, for GGT; the specificity of CDT was 81% for men and 100% for women, as compared with 82% and 72%, respectively, for GGT. Together, GGT and CDT detected 91% of the male and 93% of the female high consumers. Among younger men, CDT values were higher in the subgroup with a history of traffic offences than in the subgroup without such a history, thus suggesting that CDT levels may be increased by heavy weekend beer consumption. A few cases of false-positive CDT results were found to be attributable to genetic anomalies of the transferrin molecule. Cases characterised by disparity between the CDT level and the clinical picture require further, more specific, analysis. Used in combination with GGT, CDT is thus a feasible marker for use in monitoring alcohol consumption in drivers needing to qualify for the restoration of their licences.

Adult↗
PubMedDate not supplied

Automobile driving performance of brain-injured patients with visual field defects.

The purpose of this study was to examine whether patients with visual field defects resulting from cerebral injury are handicapped in their driving ability, because visual field loss as assessed in standard perimetry is often the basis for withdrawal of a person's driving license. Driving performance was tested on a driving simulator to obtain standardized results and for safety reasons. The visual field was assessed both with standard automated perimetry and computer-based, high-resolution, qualitative perimetry. We investigated nine patients with purely cerebral field defects (mostly homonymous binocular defects) who had no further neuropsychological or ophthalmological deficits. Their performance (driving speed, reaction time, and driving error rate) was compared with that of a control group of ten subjects. We found no differences in any of the tested parameters between the visually impaired subjects and the normal participants. This suggests that individuals with visual field defects, including those who suffer from homonymous hemianopia, may perform as adequately as normal individuals in realistic driving scenarios. The perimetrically assessed visual field may, thus, be of limited value for the prediction of driving safety, and we conclude that patients who have field defects should not summarily be denied a driving license.

Adult↗
PubMed1997

Integrated use of hair analysis to investigate the physical fitness to obtain the driving licence: a casework study.

According to the laws presently in force in Italy and the guidelines of the Driving Licence Enforcement Commission of Verona, applicants for the driving licence with a history of drug abuse undergo a medical examination, during which complete anamnestic and clinical data are recorded. On this occasion, a hair sample (50-200 mg) is collected and a urinalysis program is started consisting of EMIT controls for opiates, methadone, cocaine, barbiturates, amphetamines, cannabinoids, benzodiazepines and alcohol carried out on eight seriate samples, collected at random over about 40 days under direct supervision. The positive results from urine immunoassays are confirmed by standardized GC/MS methods. The hair samples are screened for morphine and cocaine, the most abused illicit substances in our region, using commercial RIAs adopting cut-off levels of 0.1 ng/mg. All positive samples and about 10% of negative are confirmed by HPLC. In case of confirmed positive results, the applicant is informed: if the subject denies use of opiates or cocaine in the recent months, he or she has the chance of submitting for analysis a new hair sample, which is analyzed in parallel with the hair remaining from the previous assay. In case of persisting denial, claiming analytical interferences by other drugs or endogenous substances, further confirmation of results can be carried out by CE and/or by qualitative MS/MS. In addition, hair sampling from multiple sites (scalp, axillary, pubic hair) with different susceptibility to contamination from the external sources can be carried out to rule out the possibility of passive contamination. At present, we investigate more than 700 subjects per year. The results of this integrated diagnostic strategy are presented and discussed.

Automobile Driver Examination↗
PubMed2000

A test for the determination of sustained attention in patients with obstructive sleep apnea syndrome.

BACKGROUND AND OBJECTIVES: To investigate the parameter daytime sleepiness in patients with the sleep apnea syndrome (SAS), a test for measurement of sustained attention was developed. The present studies were performed on volunteers undergoing preemployment medical examinations and SAS patients to determine the extent to which test results are in agreement with the symptoms of SAS and traffic accident reports, and also with daytime sleepiness, and whether learning or therapeutic effects can be seen with repeated tests prior to and following treatment with nasal continuous positive airway pressure (nCPAP). METHODS PARTICIPANTS: 125 healthy volunteers, and two groups of 28 SAS patients each. DESIGN: Study A: The volunteers underwent a single attention test and completed a questionnaire concerned with traffic accidents and symptoms of sleep-related breathing disorders. Study B: SAS patients underwent two attention tests before treatment. Study C: SAS patients underwent one attention test before and one after nCPAP therapy. RESULTS: Study A: The error rate in volunteers without symptoms of sleep-related breathing disorders (51 persons) was 4.7 +/- 4.3% (number of errors 14.1 +/- 12.9), 95% CI: 1.2 (number of errors 3.6). No dependence of the error rate on age, BMI or sex was found. In persons with a history of apneic events (n = 10), the error rate was 10.6 +/- 10.0% (number of errors 31.8 +/- 30), in those with more than two accidents during the last 5 years (n = 4), it was increased to 15.3 +/- 9.7% (number of errors 45.9 +/- 29.1). Study B: Among SAS patients, no significant learning effect was seen, and prolongation of the test duration beyond 30 min had no effect on the test results. Study C: The error rate improved significantly with nCPAP [10.6 +/- 13.5 vs. 6.4 +/- 8.9% (number of errors 31.8 +/- 40. 5 vs. 19.2 +/- 26.7), p < 0.001]. CONCLUSIONS: The attention test can be helpful for the measurement of daytime sleepiness, and CPAP therapy can improve test performance.

Accidents, Traffic↗
PubMed1982

Functional ability profiles for driver licensing. Exemplification by visual profile.

The impaired driver is evaluated for driver licensing according to a functional ability profile. This test correlates, in increments, the physical or medical ability of the driver with the risk categories and the vehicles the driver is permitted to operate. The person is responsible for his fitness to drive. The physician may help in patient evaluation by participation in a medical advisory board or in public education. Guidelines for 11 areas of potential driving impairments were developed in the state of Utah. These principles are illustrated with visual standards.

Automobile Driver Examination↗
PubMed1999

Psychotechnology and insanity at the wheel.

The article discusses psychological testing of automobile drivers performed by the Psychopathic Clinic affiliated with the Traffic Court of the Detroit Recorder's Court. Between 1936 and 1965 more than 15,000 drivers who had either run afoul of the traffic codes or been involved in a traffic collision. A statistical analysis of these cases reveals that the psychologists and psychiatrists working at the clinic were reinforcing existing ethnic, racial, and gender stereotypes in their pursuit of traffic safety. Patients who were deemed unfit drivers were recommended to the judges for sanctions ranging from license revokations to forced committment.

Age Factors↗