“Are you still driving?” Metasynthesis of patient preferences for communication with health care providers

Aim: The aim of this study was to synthesize published qualitative studies to identify older adults' preferences for communication about driving with health care providers.

Background: Health care providers play a key role in addressing driving safety and driving retirement with older adults, but conversations about driving can be difficult. Guides exist for family members and providers, but to date less is known about the types of communication and messages older drivers want from their health care providers.

Design: A qualitative metasynthesis of studies published on or before October 10, 2014, in databases (PubMed, CINAHL, PsycINFO, and Web of Science) and grey literature was performed.

Review Methods: Twenty-two published studies representing 518 older adult drivers met the following inclusion criteria: the study (1) was about driving; (2) involved older drivers; (3) was qualitative (rather than quantitative or mixed methods); and (4) contained information on older drivers' perspectives about communication with health care providers.

Results: We identified 5 major themes regarding older adults' communication preferences: (1) driving discussions are emotionally charged; (2) context matters; (3) providers are trusted and viewed as authority figures; (4) communication should occur over a period of time rather than suddenly; and (5) older adults desire agency in the decision to stop driving.

Conclusion: Various stakeholders involved in older driver safety should consider older drivers' perspectives regarding discussions about driving. Health care providers can respect and empower older drivers—and support their family members—through tactful communication about driving safety and mobility transitions during the life course.     

Crash risk perception of sleepy driving and its comparisons with drink driving and speeding: Which behavior is perceived as the riskiest?

Objective: Driver sleepiness is a major crash risk factor but may be underrecognized as a risky driving behavior. Sleepy driving is usually rated as less of a road safety issue than more well-known risky driving behaviors, such as drink driving and speeding. The objective of this study was to compare perception of crash risk of sleepy driving, drink driving, and speeding.

Methods: Three hundred Australian drivers completed a questionnaire that assessed crash risk perceptions for sleepy driving, drink driving, and speeding. Additionally, the participants' perceptions of crash risk were assessed for 5 different contextual scenarios that included different levels of sleepiness (low, high), driving duration (short, long), and time of day/circadian influences (afternoon, nighttime) of driving.

Results: The analysis confirmed that sleepy driving was considered a risky driving behavior but not as risky as high levels of speeding (P < .05). Yet, the risk of crashing at 4 a.m. was considered as equally risky as low levels of speeding (10 km over the limit). The comparisons of the contextual scenarios revealed driving scenarios that would arguably be perceived as quite risky because time of day/circadian influences were not reported as high risk.

Conclusions: The results suggest a lack of awareness or appreciation of circadian rhythm functioning, particularly the descending phase of circadian rhythm that promotes increased sleepiness in the afternoon and during the early hours of the morning. Yet, the results suggested an appreciation of the danger associated with long-distance driving and driver sleepiness. Further efforts are required to improve the community's awareness of the impairing effects from sleepiness and, in particular, knowledge regarding the human circadian rhythm and the increased sleep propensity during the circadian nadir.     

User experience and operational feasibility of four point-of-collection oral fluid drug-testing devices according to Brazilian traffic agents

Objective: Traffic fatalities in Brazil still rank among the highest worldwide, with an overall rate of 23.4 deaths/100,000 inhabitants/year. Although alcohol and drug use play an important role in traffic accidents, national data about their relative influence are scarce. Drug screening is not routinely performed by traffic agents because alcohol is the only substance regularly investigated in roadblocks. Therefore, we aimed to describe the initial traffic agent user experience for 4 handheld point-of-collection oral fluid drug testing devices used in routine roadblocks in Brazil, focusing on usage perceptions in hopes of generalizing this approach for other developing countries.

Methods: Four different oral fluid collection devices were evaluated: The DDS2, the DOA MultiScreen, the Dräger DrugTest 5000, and the Multi-Drug Multi-Line Twist Screen Device. Fourteen trained traffic agents obtained oral fluid from 164 drivers and performed 37 qualitative evaluations of the devices. Traffic agents filled out a questionnaire focusing on 9 feasibility criteria: Overall simplicity for roadside operation; operational success; saliva sample collection time; sample analysis time; ease of sample preparation and analysis; agreement with observed clinical signs; overall hygiene and safety; sufficient operating instructions; and hygiene of saliva collection. These were weighted based on an expert panel and yielded an overall composite device experience score that ranged from 1 (poor) to 100 (excellent).

Results: Ease of use, operational success, and acceptable collection and analysis time were considered the most important criteria by the expert panel. The results ranged from 27.3 to 88.9% for simplicity of use; 45.5 to 100.0% for operational success; 27.3 to 100% for acceptable collection time; and 36.4 to 100.0% for acceptable analysis time. The final device scores, based on the agents’ user experiences, ranked as follows: DOA MultiScreen: 49.3/100; Dräger DrugTest 5000: 82.4/100; Multi-Drug Multi-Line Twist Screen Device: 84.3/100; DDS2: 88.4/100.

Conclusion: Based on the selected criteria, 3 of the 4 devices were considered useful by traffic agents in routine roadblock operations. The weighted evaluations suggest that their ease of use (handling, sampling analysis, and reliability), as well as their agreement with findings obtained by other means, defined their utility to traffic agents, although such appraisals must be further analyzed in future studies.     

Predicting categories of drugs used by suspected drug-impaired drivers using the Drug Evaluation and Classification Program tests

Objective: The purpose of this study was to statistically determine which combination(s) of drug-related signs and symptoms from the Drug Evaluation and Classification (DEC) protocol best predict the drug category used by the suspected drug-impaired driver.

Methods: Data from 1,512 completed DEC evaluations of suspected impaired drivers subsequently found to have ingested central nervous system (CNS) depressants, CNS stimulants, narcotic analgesics, and cannabis were analyzed using a multinomial logistic regression procedure. A set of evaluations completed on drug-free subjects was also included. The relative importance of clinical, behavioral, and observational measures in predicting drug categories responsible for impairment was also examined.

Results: Thirteen drug-related indicators were found to significantly contribute to the prediction of drug category, including being under the care of a doctor or dentist, condition of the eyes, condition of the eyelids, mean pulse rate, assessment of horizontal gaze nystagmus (HGN), convergence, performance on the One Leg Stand (OLS) Test, eyelid tremors, pupil size in darkness, reaction to light, presence of visible injection sites, systolic blood pressure, and muscle tone. Indicators related to the appearance and physiological response of the eye contributed the most to the prediction of drug category, followed closely by clinical indicators and performance on the psychophysical tests.

Conclusions: The findings from this study suggest that drug recognition experts (DREs) should be careful to review a set of key signs and symptoms when determining the category of drug used by suspected drug-impaired drivers. Drug use indicators related to the appearance and physiological response of the eye were found to contribute the most to the prediction of the drug category responsible for the impairment. These results could help form the basis of a core set of indicators that DREs could initially consult to form their opinion of drug influence. This in turn may enhance the validity, effectiveness, and efficiency of drug detection and identification by DREs and lead to a more effective and efficient DEC program, improved enforcement of drug-impaired driving, and greater acceptance of the DEC program by the courts.     

Evaluating the impact of criminalizing drunk driving on years of life lost due to road traffic deaths in one megacity,China

Objective: Road safety is an important public health issue worldwide. However, few studies have analyzed the association between criminalizing drunk driving and years of life lost (YLL) due to road traffic deaths (RTDs). Our study can provide useful information about this policy.

Methods: We used interrupted time-series analysis to find the changes in monthly YLL and RTD before and after law enforcement began using RTD data from 2008 to 2014 in Tianjin.

Results: After adjustment for seasonality, months, holidays, and the number of people in each district, criminalizing drunk driving was followed by a 11.1% (95% confidence interval [CI], 1.1–21.1%) reduction in risk of RTDs and a corresponding 778.1-year (95% CI, 200–1,355.1) reduction in monthly YLL. The reduction in YLL was especially significant among males, those aged 16–64 years old, and suburban residents.

Conclusions: This study highlights that the law can lead to a reduction in YLL due to RTDs in Tianjin, China. Large immediate public health benefits resulted from the new road traffic law in China. YLL provides a complementary measure for examining the effect of criminalization on drunk driving RTDs.     

Fatally injured drivers in Norway 2005–2015—Trends in substance use and crash characteristics

Objective: Norway introduced a “Vision Zero” strategy in 2001, using multiple approaches, aiming toward a future in which no one will be killed or seriously injured in road traffic crashes (RTCs). Official statistics show that the number of fatally injured road users has declined substantially from 341 deaths in 2000 to 117 in 2015. In-depth crash investigations of all fatal RTCs started in Norway in 2005. The aim of this study was to investigate whether fatal crash characteristics, vehicle safety features, and prevalence of drugs and/or alcohol among fatally injured drivers and riders has changed during 2005–2015, accompanying the reduction in road fatalities.

Methods: Data on all car/van drivers and motorcycle/moped riders fatally injured in RTCs during 2005–2015 were extracted from Norwegian road traffic crash registries and combined with forensic toxicology data.

Results: The proportion of cars and motorcycles with antilock braking systems and cars with electronic stability control, increased significantly during the study period. The prevalence of nonuse of seat belts/helmets and speeding declined among both fatally injured drivers and riders. In addition, the prevalence of alcohol declined, though no significant change in the total prevalence of other substances was noted.

Conclusion: The observed changes toward more safety installations in cars and motorcycles and lower prevalence of driver-related risk factors like alcohol use, speeding, and nonuse of seat belts/helmets among fatally injured drivers/riders may have contributed to the decrease in road traffic deaths.     

A framework for definition of logical scenarios for safety assurance of automated driving

Abstract

Objective: In order to introduce automated vehicles on public roads, it is necessary to ensure that these vehicles are safe to operate in traffic. One challenge is to prove that all physically possible variations of situations can be handled safely within the operational design domain of the vehicle. A promising approach to handling the set of possible situations is to identify a manageable number of logical scenarios, which provide an abstraction for object properties and behavior within the situations. These can then be transferred into concrete scenarios defining all parameters necessary to reproduce the situation in different test environments.

Methods: This article proposes a framework for defining safety-relevant scenarios based on the potential collision between the subject vehicle and a challenging object, which forces the subject vehicle to depart from its planned course of action to avoid a collision. This allows defining only safety-relevant scenarios, which can directly be related to accident classification. The first criterion for defining a scenario is the area of the subject vehicle with which the object would collide. As a second criterion, 8 different positions around the subject vehicle are considered. To account for other relevant objects in the scenario, factors that influence the challenge for the subject vehicle can be added to the scenario. These are grouped as action constraints, dynamic occlusions, and causal chains.

Results: By applying the proposed systematics, a catalog of base scenarios for a vehicle traveling on controlled-access highways has been generated, which can directly be linked to parameters in accident classification. The catalog serves as a basis for scenario classification within the PEGASUS project.

Conclusions: Defining a limited number of safety-relevant scenarios helps to realize a systematic safety assurance process for automated vehicles. Scenarios are defined based on the point of the potential collision of a challenging object with the subject vehicle and its initial position. This approach allows defining scenarios for different environments and different driving states of the subject vehicle using the same mechanisms. A next step is the generation of logical scenarios for other driving states of the subject vehicle and for other traffic environments.     

Marijuana trajectories and associations with driving risk behaviors in Canadian youth

Objective: Research on risky driving practices involving marijuana use among youth and young adults often relies on cross-sectional data, which fail to account for longitudinal changes in substance use patterns. A better understanding of the longitudinal patterns of marijuana use and its effect on risky driving practices during young adulthood is needed in order to better inform prevention efforts. The current study examined whether different longitudinal patterns of marijuana use across the transition from adolescence to young adulthood are associated with impaired driving risks in young adulthood.

Methods: Data were from the longitudinal Victoria Healthy Youth Survey, which interviewed youth biennially on 6 occasions across 10 years (2003 to 2013).

Results: Youth who reported consistently high levels of marijuana use from adolescence to young adulthood (chronic users) and youth who reported increasing levels of use across this period (increasers) were more likely to engage in risky impaired driving behaviors compared to the other 3 user groups (occasional users, decreasers, and abstainers). Frequency of marijuana use was also predictive of impaired driving risks in young adulthood after controlling for individual characteristics (age, sex, socioeconomic status, age of onset of marijuana use), frequency of other substance use (heavy episodic drinking and illicit drug use), and simultaneous use of marijuana and other substances (alcohol and illicit drugs). By young adulthood, youth who use marijuana more than once a week are more likely to simultaneously use alcohol and engage in heavy episodic drinking. They are also more likely take driving risks.

Conclusions: Harm reduction strategies and legislative approaches targeting impaired driving risks associated with marijuana use should include approaches to target these high-risk groups and to reduce simultaneous use of alcohol.     

Children's and Adults’ Comfort Experience of Extra Seat Belts When Riding in the Rear Seat of a Passenger Car

Objective: The objective of this study was to explore passengers’ comfort experience of extra seat belts during on-road driving in the rear seat of a passenger car and to investigate how the use of extra belts affects children's and adults’ attitudes to the product.

Methods: Two different seat belt systems were tested, criss-cross (CC) and backpack (BP), consisting of the standard 3-point belt together with an additional 2-point belt. In total, 32 participants (15 children aged 6–10, 6 youths aged 11–15, and 11 adults aged 20–79, who differed considerably in size, shape, and proportions) traveled for one hour with each system, including city traffic and highway driving. Four video cameras monitored the test subject during the drive. Subjective data regarding emotions and perceived discomfort were collected in questionnaires every 20 min. A semistructured interview was held afterwards.

Results: All participant groups accepted the new products and especially the increased feeling of safety (P <.01); 56% preferred CC and 44% preferred BP but the difference was not significant. In total, 81% wanted to have extra seat belts in their family car. CC was appreciated for its symmetry, comfort, and the perceived feeling of safety. Some participants found CC unpleasant because the belts tended to slip close to the neck, described as a strangling feeling. BP was simpler to use and did not cause annoyance to the neck in the way CC did. Instead, it felt asymmetric and to some extent less safe than CC. Body size and shape affected seat belt fit to a great extent, which in turn affected the experience of comfort, both initially and over time. Perceived safety benefit and experienced comfort were the most determinant factors for the attitude toward the extra seat belts. The extra seat belts were perceived as being better than the participants had expected before the test, and they became more used to them over time.

Conclusion: This exploratory study provided valuable knowledge from a user perspective for further development of new seat belt systems in cars. In addition to an increased feeling of safety, seat belt fit and comfort are supplementary influencing factors when it comes to gaining acceptance of new seat belt systems.     

中国2000~2010年生态足迹变化特征及影响因素

以2000年全球平均生产力为衡量标准,核算了2000~2010年我国生态足迹,并分析了其动态变化特征和社会经济影响因素. 结果表明,2000~2010年我国生态足迹由17.69亿gha增加到32.59亿gha,年均增长6.30%; 碳足迹是10年间增长最快的生态足迹类型,由7.42亿gha增加到18.05gha,年均增长9.29%; 耕地足迹的净增幅也较大,由6.78亿gha增加到8.91亿gha; 林地、 草地、 渔业和建设用地足迹的净增幅相对较小. 2000~2010年我国人均生态足迹由1.40 gha增加到2.43gha,尽管仍低于世界平均水平,但已远超我国人均生态承载力,并造成严重的生态赤字,危及我国生态安全. 全国生态足迹的急剧增加主要受人均生态足迹的快速增长驱动,而经济增长和城镇化所带来的人均消费的产品和服务的快速增长是我国人均生态足迹快速增长的主要驱动力; 同时,国际贸易中资源密集型产品的大量出口也是驱动我国生态足迹快速增长的重要驱动因素. 如果不采取有效的控制措施,按照发达国家人均生态足迹的演变规律,随着我国由中等收入向高收入国家迈进,人均生态足迹将进一步快速增长,我国生态赤字将进一步加剧.