Graduated licensing comes to the United States. (1/61)

OBJECTIVE: To describe the young driver problem and the emergence of graduated licensing as a way to address it. METHODS: Literature review and commentary. RESULTS: Twenty-four states in the United States adopted versions of graduated licensing in 1996-98; initial results show positive effects. CONCLUSIONS: A major public health movement is under way that can be expected to produce significant reductions in crashes and injuries involving young drivers.  (+info)

Saskatchewan physicians' attitudes and knowledge regarding assessment of medical fitness to drive. (2/61)

BACKGROUND: Although legislation has been introduced in Saskatchewan for mandatory reporting by physicians of patients considered medically unfit to drive, little is known about physicians' attitudes, knowledge or resources with regard to evaluating medical fitness to drive. METHODS: The objective of this study was to determine Saskatchewan physicians' attitudes, knowledge, training, resources and current educational needs with regard to evaluating medical fitness to drive. A questionnaire survey of all physicians in the province who were identified as likely to be involved in determining medical fitness to drive was conducted between October and December 1996. RESULTS: Of the 1102 physicians who received a questionnaire, 690 (62.6%) responded, of whom 167 were excluded because they were not involved in assessing fitness to drive. Thus, 523 (55.9%) of the 935 eligible physicians surveyed completed the questionnaire. Most (57.6% [298/517]) of the respondents indicated that they do not hesitate to report patients medically unfit to drive; however, 59.5% (307/516) felt that the physician-patient relationship is negatively affected by reporting. Overall, 85.5% (444/519) of the respondents felt that restricted licensing is a fair alternative for people who might otherwise be denied a full licence. The availability of restricted licensing positively influenced the decision to report for 60.3% (313/519) of the respondents. Significantly more rural physicians than urban physicians believed that the need to drive was greater for rural residents than for urban dwellers (81.2% [95/117] v. 64.2% [257/400], p < 0.001). Physician knowledge regarding specific medical conditions and fitness to drive was generally poor. The resource most commonly used in determining medical fitness to drive was the Physicians' Guide to Driver Examination (71.1% [361/508] of respondents). The most useful continuing medical education methods indicated by physicians for assessing medical fitness to drive included conference presentations, workshops and journal articles. INTERPRETATION: Most of the Saskatchewan physicians surveyed supported restricted licensing, and the availability of restricted licensing made them more likely to report patients considered medically unfit to drive. The physician-patient relationship was felt to be negatively affected by reporting.  (+info)

Older drivers--a complex public health issue. (3/61)

OBJECTIVES: This article provides estimates of the percentage of seniors who are licensed to operate a motor vehicle. It describes the health characteristics of these license holders and reviews research relating to older drivers. DATA SOURCES: The data are from the cross-sectional file of Statistics Canada's 1996/97 National Population Health Survey. The sample size of respondents aged 65 or older was 13,363, weighted to represent 3.4 million individuals. Supplementary data are from the 1991 Survey of Ageing and Independence, also conducted by Statistics Canada, and from Transport Canada. ANALYTICAL TECHNIQUES: The percentages of seniors with a license were calculated by age and sex. Percentages by presence of chronic conditions, disabilities and medication use were age-standardized to control for the increasing prevalence of illness at older ages. MAIN RESULTS: The percentage of seniors who had a driver's license declined with advancing age. The negative association between disability and license holding was pronounced. The percentage of seniors with a driver's license was also relatively low among those with heart disease, arthritis, stroke or cataracts, and among those who reported taking selected medications in the last month.  (+info)

Risks older drivers face themselves and threats they pose to other road users. (4/61)

BACKGROUND: Although there is an ever increasing literature on older drivers, there is no comprehensive up-to-date presentation of how older drivers are impacted by traffic safety, and how they impact the road safety of others. METHODS: This paper uses 1994-1996 US data to determine how many rates related to traffic safety depend on the age and sex of road users (fatalities, fatalities per licensed driver, etc.) Threats drivers pose to other road users are estimated by driver involvement in pedestrian fatality crashes. RESULTS: It is found that renewing the licence of a 70-year-old male driver for another year poses, on average, 40% less threat to other road users than renewing the license of a 40-year-old male driver. The fatality risks drivers themselves face generally increase as they age, with the increased risk of death in the same severity crash being a major contributor. If this factor is removed, crash risks for 70-year-old male drivers are not materially higher than for 40-year-old male drivers; for female drivers they are. CONCLUSIONS: Most driver rates increase substantially by age 80, in many cases to values higher than those for 20-year-olds. Given that a death occurs, the probability that it is a traffic fatality declines steeply with age, from well over 20% for late teens through mid twenties, to under one per cent at age 65, and under half a per cent at age 80.  (+info)

Survey on health status of heavy vehicle drivers in Klang valley. (5/61)

A survey was carried out using a medical examination format that was prepared by the Malaysian Medical Association. The findings of the survey show that of the 266 cases surveyed, 64 drivers (24% of cases surveyed) are either totally unfit to drive or temporarily unfit to drive heavy goods and passenger vehicles. This is clear indication that the current format that is being used by the Road Transport Department is inadequate and needs to be reviewed. It must also be stressed that all the above 64 drivers have been certified fit using the existing Road Transport Department format and are currently driving in our highways and roads. Heavy vehicle goods and passenger vehicle drivers if not properly examined and medically certified are not only be endangering their own lives but also that of others. It is therefore recommended that based on the data available from this survey, the Road Transport Department should seriously consider adopting the medical examination format that was formalised by the Malaysian Medical Association and used in this survey.  (+info)

A test for the determination of sustained attention in patients with obstructive sleep apnea syndrome. (6/61)

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.  (+info)

The effect of state regulations on motor vehicle fatalities for younger and older drivers: a review and analysis. (7/61)

Policymakers have had a long-standing interest in improving the motor vehicle safety of both younger and older drivers. Although younger and older drivers share the distinction of having more crashes and fatalities per mile driven than other age groups, the problems posed by these two groups stem from different origins and manifest in different ways. A number of state-level policies and regulations may affect the number of motor vehicle crashes and fatalities in these two high-risk groups. A critical review of the existing literature in regard to the risk factors and the effects of various policy measures on motor vehicle crashes in these two high-risk populations provides direction for policymakers and high-priority areas of interest for the research community.  (+info)

Detection of visual field defects in patients after anterior temporal lobectomy for mesial temporal sclerosis-establishing eligibility to drive. (8/61)

AIMS: The aim of this study is to quantify visual field defects after temporal lobectomy for mesial temporal sclerosis and to establish eligibility for driving. METHODS: Automated static perimetry was performed on 14 patients who had undergone anterior temporal lobectomy for mesial temporal sclerosis. Perimetry consisted of monocular Humphrey Field Analyser (HFA) 30-2 test and a binocular Esterman 120 test. RESULTS: Of the 14 patients, three had no loss or non-specific loss, eight had partial homonymous quadrantanopia, one had complete homonymous quadrantanopia and two had concentric loss attributable to vigabatrin, which may have masked any loss occurring due to surgery. Of these, only seven passed the standardised DVLA visual fields. Of the seven who failed DVLA visual field, one had complete quadrantanopia, four had partial quadrantanopia and two had concentric loss (due to vigabatrin). CONCLUSIONS: Visual field defects contribute a great deal in the reduction of the quality of life in patients who have had surgery for mesial temporal sclerosis. Potential surgically induced visual field defects that could preclude driving need to be discussed with each patient preoperatively. In our study 50% of patients did not meet the required DVLA standards.  (+info)