An Observational Study of the Morning and Evening Behavior of Individuals With and Without Attention-Deficit/Hyperactivity Disorder

Evidence of ADHD symptoms and impairments were documented in the morning and evening hours for individuals diagnosed with ADHD. These results illustrate additional areas in need of attention in the refinement of treatments for adults with ADHD.

Adverse driving behaviors are associated with sleep apnea severity and age in cognitively normal older adults at risk for Alzheimer's disease

Alzheimer's disease (AD) pathology accumulates for decades before the onset of cognitive decline. Cognitively normal individuals with biomarker evidence of AD brain pathology (i.e. biomarker + or preclinical AD) can be differentiated from individuals without AD brain pathology based on naturalistic driving data, such as hard acceleration or braking and speeding, measured using in-vehicle dataloggers. Older adults are at increased risk of injury and death from motor vehicle crashes and driving cessation is also linked to negative health outcomes. Identifying potentially modifiable risk factors that increase driving risk may prolong safe driving in old age. Sleep apnea is associated with adverse driving behaviors across the age span. In this study, we hypothesized that high-risk driving behaviors would be associated with increased sleep apnea severity and AD pathology. We found that higher sleep apnea severity measured by a home sleep apnea test was associated with a higher incidence of adverse driving behaviors even after controlling for multiple confounders (β = 0.24 ± 0.09, p < 0.01). This association was independent of AD biomarker positivity (i.e. increased t-tau/Aβ 42 ratio). Increasing age was associated with a higher likelihood of high-risk driving behaviors in individuals with AD brain pathology (β = 0.12 ± 0.04, p < 0.01), but a lower likelihood in individuals without AD brain pathology (β = -0.06 ± 0.03, p < 0.05). These findings suggest that adverse driving behaviors linked to a higher rate of traffic crashes in older adults are associated with sleep apnea severity and AD pathology even in cognitively unimpaired individuals. Further studies are needed to determine if treatment of sleep apnea decreases high-risk driving behaviors and therefore motor vehicle crashes.

Opportunities and Limitations of a Gaze-Contingent Display to Simulate Visual Field Loss in Driving Simulator Studies

Background

Research on task performance under visual field loss is often limited due to small and heterogenous samples. Simulations of visual impairments hold the potential to account for many of those challenges. Digitally altered pictures, glasses, and contact lenses with partial occlusions have been used in the past. One of the most promising methods is the use of a gaze-contingent display that occludes parts of the visual field according to the current gaze position. In this study, the gaze-contingent paradigm was implemented in a static driving simulator to simulate visual field loss and to evaluate parallels in the resulting driving and gaze behavior in comparison to patients.

Methods

The sample comprised 15 participants without visual impairment. All the subjects performed three drives: with full vision, simulated left-sided homonymous hemianopia, and simulated right-sided homonymous hemianopia, respectively. During each drive, the participants drove through an urban environment where they had to maneuver through intersections by crossing straight ahead, turning left, and turning right.

Results

The subjects reported reduced safety and increased workload levels during simulated visual field loss, which was reflected in reduced lane position stability and greater absence of large gaze movements. Initial compensatory strategies could be found concerning a dislocated gaze position and a distorted fixation ratio toward the blind side, which was more pronounced for right-sided visual field loss. During left-sided visual field loss, the participants showed a smaller horizontal range of gaze positions, longer fixation durations, and smaller saccadic amplitudes compared to right-sided homonymous hemianopia and, more distinctively, compared to normal vision.

Conclusion

The results largely mirror reports from driving and visual search tasks under simulated and pathological homonymous hemianopia concerning driving and scanning challenges, initially adopted compensatory strategies, and driving safety. This supports the notion that gaze-contingent displays can be a useful addendum to driving simulator research with visual impairments if the results are interpreted considering methodological limitations and inherent differences to the pathological impairment.

Driving and exceptional cases: Supporting relicensing evaluation in patients whose visual fields fail to meet standards

PURPOSE

The UK Driver and Vehicle Licensing Agency's (DVLA) visual field criteria mean that homonymous defects close to fixation are not usually acceptable for driving. Here, we illustrate cases where patients with field defects failing to meet standards had their licences revoked but subsequently were permitted to drive again through exceptional case provisions.

METHODS

Clinical assessment of two patients with homonymous loss: a 62-year-old man (PWT) with a dense left upper homonymous quadrantanopia secondary to a right occipital lobe stroke and a 48-year-old woman (JC), only aware of right upper homonymous quadrantanopia following routine primary care assessment and subsequently attributed to left middle cerebral artery stroke from perinatal intracranial haemorrhage.

RESULTS

PWT's Esterman test showed a significant central defect failing to meet the standard. His subsequent ophthalmic examination was otherwise unremarkable with excellent visual functions. Clinical evidence was provided supporting his relicensing application, and in time, a practical DVLA driving assessment indicated adaptation had been successful, and his licence was restored. JC's defect also failed to meet the standard, and her licence was revoked. Her ophthalmic examination was otherwise unremarkable, and her condition was attributed to a nonprogressive, isolated perinatal event. The DVLA accepted supporting clinical evidence; her subsequent practical driving assessment demonstrated successful adaptation and her licence was also restored.

CONCLUSIONS

Conventional visual field tests are not necessarily predictive of real-world driving performance, with drivers' adaptive strategies not being accommodated. In the UK, individuals with visual field loss failing to meet the standard may be eligible for relicensing as exceptional cases if specific criteria can be met. For exceptional cases potentially licensable under these criteria, the DVLA requires clinician support and a satisfactory practical driving assessment. Similar provisions exist internationally. Clinicians need to be aware of the role they may play in such scenarios.

Factors Associated With Driving Status Among Brazilian Older Adults

This study analyzed the factors associated with driving status among older adults in Brazil. The sample consisted of 15,221 older adults (≥65 years) residing in Brazilian capitals in 2018. The following question established the participants' driving status: "Do you drive a car, motorcycle, and/or another vehicle?" Sociodemographic, health conditions, and health-related behaviors were derived through standard procedures. Poisson regression analysis was performed to estimate prevalence ratios and 95% confidence interval. The prevalence of drivers was 28.83%. We found that being physically active during leisure time and higher daily recreational screen time (>3 h/day) were associated with driving status. Self-perceived negative health and being physically active by commuting showed an inverse association with driving status. The high prevalence of older drivers and the characteristics associated with driving reinforces the importance of public policy strategies for these individuals.

The effect of aging on decision-making while driving: A diffusion model analysis

We present a diffusion model analysis of the effect of aging on decision processes during driving. Our goal was to examine the changes in the underlying components as a function of age and both task and environment difficulty. Younger and older adults performed each of three decision-making tasks while operating a computer-based driving simulator in which the task required a driving action. The first task was a one-choice task in which the response to brake lights turning on was to drive around a lead car. The second and third tasks were two-choice brightness-discrimination tasks in which participants were asked to drive the car to the left/right if there were more black/white pixels in an array of black and white pixels. Results showed that older adults were slower in the one-choice task and made more errors in the two-choice tasks than younger adults. The behavioral data were fitted well by one- and two-choice diffusion models, showing lower evidence accumulation rates (drift rates) in older than younger adults. Moreover, in the two-choice tasks under higher environmental demands, older adults showed a lower decision criterion (boundary separation) to compensate for a slower decision process. Together, the differences we found in the decision components between age groups provided an example of a subtle interaction between speed and accuracy in older versus younger adults, and this demonstrates the utility of this modeling approach in studying age effects in driving. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Toward a Theory of Visual Information Acquisition in Driving

OBJECTIVE

The aim of this study is to describe information acquisition theory, explaining how drivers acquire and represent the information they need.

BACKGROUND

While questions of what drivers are aware of underlie many questions in driver behavior, existing theories do not directly address how drivers in particular and observers in general acquire visual information. Understanding the mechanisms of information acquisition is necessary to build predictive models of drivers' representation of the world and can be applied beyond driving to a wide variety of visual tasks.

METHOD

We describe our theory of information acquisition, looking to questions in driver behavior and results from vision science research that speak to its constituent elements. We focus on the intersection of peripheral vision, visual attention, and eye movement planning and identify how an understanding of these visual mechanisms and processes in the context of information acquisition can inform more complete models of driver knowledge and state.

RESULTS

We set forth our theory of information acquisition, describing the gap in understanding that it fills and how existing questions in this space can be better understood using it.

CONCLUSION

Information acquisition theory provides a new and powerful way to study, model, and predict what drivers know about the world, reflecting our current understanding of visual mechanisms and enabling new theories, models, and applications.

APPLICATION

Using information acquisition theory to understand how drivers acquire, lose, and update their representation of the environment will aid development of driver assistance systems, semiautonomous vehicles, and road safety overall.

With a Little Help From My Friends and Family: Transportation and Caregiving Hours

OBJECTIVES

To better understand the associations between the driving status of the care recipient and caregiver with provided caregiving hours, more research on the relationships between contextual caregiving factors and driving-related behaviors is needed.

METHOD

Using data from Round 7 of the National Health and Aging Trends Study (NHATS) and the linked National Survey of Caregiving (NSOC; n = 1054 dyads), this study explored how caregiver transportation assistance and care recipient driving frequency are associated with caregiving hours.

RESULTS

Caregiving hours were highest among caregivers who provided transportation every day and among care recipients who had not driven in the last month. After controlling for covariates, negative binomial regression results indicated that greater caregiver transportation assistance was related to more caregiving hours, while greater care recipient driving frequency was related to less caregiving hours.

CONCLUSION

Integrated supports and greater accessibility to transportation services may decrease time spent caregiving.

Impact of the COVID-19 Pandemic on Older Adult Driving in the United States

OBJECTIVES

To examine how the COVID-19 pandemic affected driving and health outcomes in older adults.

METHODS

We compared Advancing Understanding of Transportation Options (AUTO) study participants enrolled before (December 2019 to March 2020) versus during the pandemic (May 2020 to June 2021). Participants were English-speaking, licensed drivers (≥70 years) who drove weekly and had a primary care provider at a study site and ≥1 medical condition potentially associated with driving cessation. We used baseline self-reported measures on mobility and health.

RESULTS

Compared to those enrolled pre-COVID-19 (n = 61), more participants enrolled during COVID-19 (n = 240) reported driving reductions (26% vs. 70%, p < .001) and more often for personal preference (vs. medical/emotional reasons). While mean social isolation was higher during than pre-COVID-19, self-reported depression, stress, and overall health PROMIS scores did not differ significantly.

DISCUSSION

Our findings highlight the resiliency of some older adults and have implications for mitigating the negative effects of driving cessation.

Older adult driving performance assessed under simulated and on-road conditions

Simulated driving offers a convenient test of driving ability for older drivers, although the viability of using simulated driving with this population is mixed. The relative weighting of the relevant perceptual, cognitive, and physical factors may vary between simulated and on-road driving. The current study was designed to assess this possibility. We conducted simulated and on-road driving tests of 61 older adults aged 66-92 years. To ensure that the driving performance was measured similarly between the two driving modalities, we employed the Record of Driving Errors (RODE) driving assessment system during both driving tests. Correlation and random weights analysis (RWA) results indicated only modest evidence of correspondence between the simulated and on-road driving performances. The primary factors operative in both simulated and on-road driving was Useful Field of View and a measure of basic cognition. Unique factors for simulated driving included a measure of physical mobility (Time-Up-and-Go) and spatial reasoning (Line), and for on-road driving included chronological age and sensorimotor processing (Trail-Making Task A). Chronological age was correlated primarily the on-road rather than simulated test, was greatly reduced with the inclusion of additional explanatory factors, and likely reflects driving efficiency rather than driving safety. We conclude that simulated driving in healthy older drivers can be beneficial for research purposes to assess cognitive and perceptual factors that underly driving effectiveness, although it cannot serve as a clear proxy for on-road driving.

The effects of intranasal esketamine on on-road driving performance in patients with major depressive disorder or persistent depressive disorder

BACKGROUND

Intranasal esketamine demonstrates rapid improvement of depressive symptoms. However, transient adverse effects (dissociation, sedation and dizziness) may occur, which could impact driving performance.

AIMS

To evaluate the effects of 84 mg intranasal esketamine on driving performance in unipolar major depressive disorder (MDD) or persistent depressive disorder (PDD) patients.

METHODS

The study consisted of two parts. Part A was a single-blind, double-dummy, randomized three-period, cross-over study to compare effects of esketamine versus placebo on next morning driving, 18 ± 2 h post-treatment. Alcohol was administered to demonstrate assay sensitivity. In Part B, same-day driving, 6 ± 0.5 hours post-treatment, was assessed during twice weekly esketamine administration for 3 weeks. Twenty-seven patients with mild-to-moderate MDD or PDD without psychotic features completed a 100 km on-the-road driving test on a public highway in normal traffic. The primary outcome was standard deviation of lateral position (SDLP; cm; weaving of car).

RESULTS

In Part A, alcohol impaired driving performance compared to placebo: Least-square means (95% CI), p-value for delta SDLP (cm) compared with placebo: (ΔSDLP = + 1.83 (1.03; 2.62), p < 0.001), whereas esketamine did not: (ΔSDLP = -0.23 (-1.04; 0.58), p = 0.572). In Part B, weekly driving tests showed no differences between placebo baseline SDLP and after esketamine administration over 3 weeks: Day 11: (ΔSDLP = -0.96 (-3.72; 1.81), p = 0.493), Day 18: (ΔSDLP = -0.56 (-3.33; 2.20), p = 0.686) and Day 25: (ΔSDLP = -1.05 (-3.82; 1.71), p = 0.451).

CONCLUSIONS

In this study, esketamine did not impair on-road driving performance the next morning following a single dose, or on same day after repeated administration.

Social Box: Influence of a New Housing System on the Social Interactions of Stallions When Driven in Pairs

In order to improve the housing conditions of stallions in individual boxes, we tested a so-called “social box” allowing increased physical contact between neighbouring horses. This study investigated whether housing stallions in social boxes changes the number of social interactions during carriage driving. We hypothesised that the stay in social boxes would decrease the number of unwanted social interactions between stallions when driven in pairs. Eight Franches-Montagnes breeding stallions were observed when driven in pairs with a “neutral” stallion housed in a so-called “conventional box”, strongly limiting physical contact. They were driven on a standardised route over the course of four days before, during, and after being housed in social boxes. The type and frequency of behaviours of the pairs and the interventions of the groom and the driver during the test drives were assessed live and using video recordings. Results from linear mixed-effect models show that unwanted social interactions decreased during and after the stallions were housed in the social box (p < 0.001). Stallions’ interactions also decreased over the four days (p < 0.01), suggesting a habituation to the test conditions by learning not to interact, or by subtly settling dominance. The social box tended to decrease unwanted social behaviours of stallions driven in pairs and could therefore be used as an environmental enrichment for horses.

"Is it time to stop driving?": A randomized clinical trial of an online decision aid for older drivers

BACKGROUND

Many older adults face the difficult decision of when to stop driving. We sought to test whether an online driving decision aid (DDA) would improve decision quality.

METHODS

This prospective two-arm randomized trial enrolled English-speaking licensed drivers (age ≥70 years) without significant cognitive impairment but with ≥1 diagnosis associated with increased likelihood of driving cessation; all participants received primary care in clinics associated with study sites in three states. The intervention was the online Healthwise® DDA for older adults addressing "Is it time to stop driving?"; control was web-based information for older drivers only. The primary outcome was decision conflict as estimated by the Decisional Conflict Scale (DCS; lower scores indicate higher quality). Secondary outcomes were knowledge and decision self-efficacy about driving decisions. We examined postrandomization differences in primary and secondary outcomes by study arm using generalized linear mixed-effects models with adjustment for site and prerandomization scores.

RESULTS

Among 301 participants (mean age: 77.1 years), 51.2% identified as female and the majority as non-Hispanic (99.0%) and white (95.3%); 98.0% lived in an urban area. Participant characteristics were similar by study arm but differed across sites. Intervention participants had a lower mean DCS score (12.3 DDA vs 15.2 control; adjusted mean ratio [AMR] 0.76, 95%CI 0.61-0.95; p = 0.017). Intervention participants had higher mean knowledge scores (88.9 DDA vs. 79.9 control; OR 1.13, 95%CI 1.01-1.27, p = 0.038); there was no difference between groups in self-efficacy scores. The DDA had high acceptability; 86.9% of those who viewed it said they would recommend it to others in similar situations.

CONCLUSIONS

The online Healthwise® DDA decreased decision conflict and increased knowledge in this sample of English-speaking, older adults without significant cognitive impairment, although most chose to continue driving. Use of such resources in clinical or community settings may support older adults as they transition from driving to other forms of mobility.

TRIAL REGISTRATION

ClinicalTrials.gov identifier "Advancing Understanding of Transportation Options (AUTO)" NCT04141891.

Using Automated Vehicle Technologies With Older Adults: A Mixed-Methods Study

When older adults' driving abilities decline, automated driving technologies may improve community mobility, engagement, and independence. Most previous research has focused on older persons' attitudes rather than their use of automated driving technologies. This study examined older Australians' perceptions and experience of automated vehicle technologies before, during, and after a real-life driving experience, focusing on ease of use, usefulness, safety, acceptance, trust, and confidence. This mixed-methods study included observation of a 6-km test drive using a partially automated vehicle, pre- and post-drive questionnaires, and a post-drive semi-structured interview. Most participants reported positive perceptions and experiences before, during, and after the test drive. Visual analysis of pre/postresponses revealed divergent reactions to the test drive, consistent with the heterogeneity of the older population. Automated driving technologies have potential to contribute to mobility at older ages. Larger-scale studies including actual driving experiences are recommended.

Relative effectiveness of general versus specific cognitive training for aging adults

In the present study, we examined three experimental cognitive interventions, two targeted at training general cognitive abilities and one targeted at training specific instrumental activities of daily living (IADL) abilities, along with one active control group to compare benefits of these interventions beyond expectation effects, in a group of older adults (N = 230). Those engaged in general training did so with either the web-based brain game suite BrainHQ or the strategy video game Rise of Nations, while those trained on IADL skills completed instructional programs on driving and fraud awareness. Active control participants completed sets of puzzles. Comparing baseline and postintervention data across conditions, none of the preregistered primary outcome measures demonstrated a significant interaction between session and intervention condition, indicating no differential benefits. Analysis of expectation effects showed differences between intervention groups consistent with the type of training. Those in the IADL training condition did demonstrate superior knowledge for specific trained information (driving and finances). Twelve months after training, significant interactions between session and intervention were present in the primary measure of fraud detection, as well as the secondary measures of the letter sets task and Rey's Auditory Verbal Learning Test. However, the specific source of these interactions was difficult to discern. At 1-year follow-up those in the IADL condition did not maintain superior knowledge of driving and finances gained through training, as was present immediately postintervention. Hence, the interventions, when compared to an active control condition, failed to show general or specific transfer in a meaningful or consistent way. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Effects of High-Potency Cannabis on Psychomotor Performance in Frequent Cannabis Users

Background: Recently increased access to cannabis products in the United States has been associated with increased rates of driving after cannabis use. Although numerous studies indicate that cannabis impairs psychomotor and neurocognitive functions that can affect driving ability, the determination of cannabis-impaired driving risk is complicated by the extent to which frequent cannabis users develop tolerance to THC's subjective, cognitive, and psychomotor effects, and by the fact that there is no validated behavioral or biological marker of recent cannabis use or cannabis-related impairment. This study examined the psychomotor impairment-related effects experienced by frequent cannabis users in Colorado after naturalistic consumption of smoked cannabis, both immediately and 1 h postuse. Results were then validated in a smaller replication sample from Washington state. Methods: In the primary Colorado study, participants (n=70) used the DRUID^® mobile app, a brief measure of psychomotor and cognitive domains that are sensitive to the effects of cannabis. First, participants used DRUID to establish a sober baseline impairment score. During a second appointment, they used DRUID at three time points: preuse, immediately after acutely using cannabis, and 1 h postuse. In the Washington replication sample, participants (n=39) used DRUID before acute cannabis consumption and then every half hour for 2.5 h. Results: In both studies, peak DRUID impairment effects were seen immediately after cannabis use, with recovery of performance at 1 h postuse. Specifically, significant quadratic effects of time emerged for both studies (Colorado study: (β=-0.935, SE=0.204, p<0.001); Washington study: β=3.0299, SE=1.3085, p<0.01). Domain-specific effects were tested in the larger Colorado study and were observed for reaction time within a complex divided attention task and a postural-stability balance task. Conclusions: These findings demonstrate that psychomotor impairment emerges immediately after acute cannabis use even in regular users, but decreases significantly 1 h postuse. These results underscore the potential utility of the DRUID app for assessing acute cannabis-related psychomotor impairment. Further research is needed to explore whether the DRUID app and/or the specific psychomotor functions it assesses might serve as a tool for measuring cannabis-related driving impairment. Clinical trials registration number for the Colorado Study: NCT03522103.

Driving After Cannabis Use Among Young Adults in Michigan

Introduction: Driving after cannabis use is associated with a number of risks. Examination of driving after cannabis use among young adults is particularly important, as young adults have the highest rates of cannabis use and among the highest rates of traffic crashes. The current study examines rates and correlates of driving after cannabis use among young adults (aged 18-25) who reported past month cannabis use. Methods: Participants were from Michigan and recruited through paid Facebook and Instagram advertisements between February and March 2018 (n=461). Results: Nearly a third (31.9%) of the sample reported driving after cannabis use in the past month. Young adults who were employed (aOR=1.872, p=0.045), had medical cannabis cards (aOR=2.877, p<0.001), endorsed coping reasons for use (aOR=2.992, p=0.007), and endorsed social/recreational reasons for use (aOR=1.861, p=0.034) had greater odds of driving after cannabis use. Students had lower odds of driving after use (aOR=0.573, p=0.011). Conclusions: Employment and having a medical cannabis card may be important risk markers for identifying individuals more likely to drive after use of cannabis. Prevention efforts could provide psychoeducation at dispensaries to individuals with medical cannabis cards about the risks of driving after use. Coping motives for cannabis use may also be useful in identifying young adults at the greatest risk of driving after use of cannabis.

The regulation of driving with non-epileptic seizures must be made clearer

Patients with epilepsy have their authorisation to drive restricted under detailed guidelines, but the rules for those with non-epileptic seizures are far less clear. We surveyed specialist clinicians in Australia and found little agreement as to whether such guidelines existed for non-epileptic seizures or what they might be. A number of possible interpretations of the Australian fitness to drive guidelines are explored, and these are often vague in themselves, as well as uncertain in their scope. This means clinicians making momentous driving decisions for their patients with non-epileptic seizures are doubly challenged, first in interpreting what guidelines exist, and second in what they mean. The International League Against Epilepsy proposed specific guidelines for driving with non-epileptic seizures, which reflect the range of presentations of non-epileptic seizures in a decision-making algorithm. We believe a specific algorithm such as this is essential in removing one level of uncertainty and responsibility for clinicians, and restoring equity for patients with non-epileptic seizures.

Opioids and the Risk of Motor Vehicle Collision: A Systematic Review

Background: Opioid analgesics are among the most commonly prescribed medications, but questions remain regarding their impact on the day-to-day functioning of patients including driving. We set out to perform a systematic review on the risk of motor vehicle collision (MVC) associated with prescription opioid exposure. Method: We searched Medline, PubMed, EMBASE, Scopus, and TRID from January 1990 to August 31, 2021 for primary studies assessing prescribed opioid use and MVCs. Results: We identified 14 observational studies that met inclusion criteria. Among those, 8 studies found an increased risk of MVC among those participants who had a concomitant opioid prescription at the time of the MVC and 3 found no significant increase of culpability of fatal MVC. The 3 studies that evaluated the presence of a dose-response relationship between the dose of opioids taken and the effects on MVC risk reported the existence of a dose-response relationship. Due to the heterogeneity of the different studies, a quantitative meta-analysis to sum evidence was deemed unfeasible. Our review supports increasing evidence on the association between motor vehicle collisions and prescribed opioids. This research would guide policies regarding driving legislation worldwide. Conclusion: Our review indicates that opioid prescriptions are likely associated with an increased risk of MVCs. Further studies are warranted to strengthen this finding, and investigate additional factors such as individual opioid medications, opioid doses and dose adjustments, and opioid tolerance for their effect on MVC risk.

A Clinical Framework for Assessing Cannabis-Related Impairment Risk

Clinicians play an important role in promoting safe and responsible medical cannabis use. One essential component to safe use is considering a patient's risk of neurocognitive impairment. However, there remains a lack of practical guidance on how clinicians can evaluate this risk for medical cannabis patients. Here, a practical framework is presented for clinicians to assess and stratify cannabis-associated impairment risk. The proposed framework is intended to practically guide healthcare providers in gaining a more comprehensive review of a patient's impairment-related factors. This framework can be used to assess impairment risk for patients currently using or considering medical cannabis and is recommended for all patients who perform safety-sensitive duties. Healthcare providers (HCP) managing patient's medical cannabis or those conducting assessments to determine risk of impairment for safety-sensitive workplaces can utilize this framework to stratify patients' risk of impairment. Such assessments can inform patient-specific needs for support, education, and guidance, to ensure cannabis is used safely and responsibly.

Physical and cognitive demands associated with police in-vehicle technology use: an on-road case study

Motor vehicle crashes are a leading cause of police officers' deaths in line of duty. These crashes have been mainly attributed to officers' driving distraction caused by the use of in-vehicle technologies while driving. This paper presents a 3-h ride-along study of 20 police officers to assess the physical and cognitive demands associated with using in-vehicle technologies. The findings suggested that the mobile computer terminal (MCT) was the most frequently used in-vehicle system for the officers. In addition, officers perceived the MCT to significantly increase their visual, cognitive, and physical demands compared to other in-vehicle technologies. Evidence from electromyography and eye-tracking measures suggested that officers with more experience as a patrol officer and those who were working in more congested areas experienced higher cognitive workload. Furthermore, it was found that as the ride-along duration increased, there were indications of muscle fatigue in medial deltoid and triceps brachii muscles. Practitioner summary: This study assessed the impact of police in-vehicle technology use in an on-road case study. The findings provide new data and knowledge for police agencies and vehicle manufacturers to develop administrative measures and in-vehicle technology innovations to improve police officers' health and safety.

A Prospective Study on the Relationship Between Driving and Non-occupational Computer Use With Risk of Dementia

Sedentary behaviors have been associated with the risk of dementia in older adults. Whether driving and computer use are associated with the risk of dementia in older adults is an important research question. The participants of a longitudinal cohort study that included European middle- and old-aged adults at the baseline (2006-2010) who had not been diagnosed with dementia before 5 years after the baseline and had not died within 5 years after the baseline were followed up (until 2018) and analyzed. The associations between driving and non-occupational computer use time measured by the questionnaire at the baseline and incident dementia 5 years after the baseline were analyzed after correcting for confounding variables. Each analysis included approximately 370,000 participants and 1,000 cases. According to Cox proportional hazard models that divide subjects into four groups of habit duration levels [(a) 0 h; (b) less than 1 h, 1 h; (c), 2 h, 3 h; (d) 4 h or more, per/day)], the group with 0 h < driving time ≤1 h at the baseline exhibited a significantly lower risk of incident dementia than the other groups. In addition, in the analysis of non-occupational computer use duration, the 0 h group exhibited a significantly higher risk than the other groups. Our results indicate that different sedentary behaviors have different associations with dementia risk over time and have no simple dose-response relationship with dementia risk. The sedentary behavior risk assessments must consider these factors.

Alcohol and Alcohol Combined with Texting: Evaluation of Driving Impairment Effects in a Closed-Course Section

OBJECTIVE

Examine the driving impairment effects of alcohol alone and of alcohol combined with texting.

METHODS

Fifteen drivers (nine male, six female; mean age: 31.1 ± 6.9 years, range: 23 to 43 years) with similar drinking habit (i.e., social drinkers) completed a lap in a closed-course section in six different situations: (I) sober; (II) sober and while texting; (III) 30 minutes after ingesting a moderate dose of ethanol (0.50 g/kg); (IV) 30 minutes after drinking and while texting; (V) 60 minutes after drinking, (VI) 60 minutes after drinking and while texting. Driving performance was analyzed by means of maximum and mean speed, braking time and braking distance; and ability to control the car (i.e., evaluating if the drivers hit a traffic cone or exceeded the boundaries of the course). P values of < 0.05 were considered significant.

RESULTS

Pre and post-alcohol consumption results show a significant increase concerning the drivers' mean and maximum speed after drinking (p < 3.2x10^-8). However, neither alcohol nor texting had significant effects on braking parameters (p > 0.05). Traffic cones were knocked down only in texting experiments. In addition, when using the cell phone drivers tended to reduce the speed, and to accelerate abruptly right after they finish texting.

CONCLUSION

Our findings strengthen the hypothesis that even moderate alcohol doses may significantly impair the driving performance. Additionally, alcohol and texting have complementary effects on driving impairment, and their combination represents a significant risk factor for crashes.

Introducing practical tools for fit to drive assessment of the elderly: A step toward improving the health of the elderly

Today, as age increases, the demand for independent living has increased. Since driving is one of the safest and preferred ways for the elderly to travel, paying close attention to the accurate assessment of the elderly's driving ability can prevent traffic accidents in this age group. The purpose of this study was to identify and introduce practical tools for drive assessment fitness of the elderly. This systematic review was conducted according to Cochrane methodology and reported findings according to PRISMA. The following databases were searched from PubMed, ISI web of knowledge, Scopus, ProQuest, Medlib, SID, Magiran, Iran doc, and Iran Medex based on the population intervention comparison outcome method. The total records involving 12 main tools were assessed from 26 selected records in the final evaluation. The research findings indicated the selection of seven tools in the psycho-cognitive function domain such as TMT-B, Clock Drawing Test, MAZE, Montreal Cognitive Assessment, GDS-15, MMSE, and ACE-R, three tools in the sensory function domain such as Snellen, Confrontation Visual field, and Whispered Voice Test, and also two tools in motor function domain such as Rapid pace walk, and Manual test of the range of motion. The findings led to selecting practical, accurate, and fast tools for widespread use for the assessment of driving competencies of the elderly. Therefore, it is recommended that the selected tools be used in practical batteries to assess the driving skills of the elderly.